罗哌卡因联合布托啡诺或芬太尼用于硬膜外分娩镇痛效果研究及对母婴结局的影响

Study on Analgesic Effect of Ropivacaine Combined with Butorphanol or Fentanyl in Epidural Labor Analgesia and Its Influence on Mothers and Infants

摘要: 目的：探讨比较采用0.115%罗哌卡因联合布托啡诺或芬太尼用于硬膜外分娩镇痛的效果和对母婴结局的影响。方法：将自愿要求分娩镇痛的90名单胎、足月初产妇，按各30名的比例随机分成3组，A组：0.115%罗哌卡因复合布托啡诺20 μg/ml，B组：0.115%罗哌卡因复合芬太尼1.5 μg/ml，C组：0.115%罗哌卡因用于硬膜外分娩镇痛。观察并比较3组产妇镇痛起效时间(VAS ≤ 3分)、初次PCA时间、用药总量，记录并比较3组产妇的生命体征变化、不良反应、新生儿Apgar评分及分娩方式等。结果：VAS分值比较，三组镇痛后较镇痛前均显著降低(3组产妇镇痛前VAS评分 ≥ 7分，镇痛后VAS评分 ≤ 3分) (p < 0.05)；镇痛效果方面，A组与B、C组比较，镇痛起效时间加快，初次PCA用时缩短、PCA有效次数减少、用药总量减少(p < 0.05)，Ramsay镇静评分较高；不良反应方面，C组与A组、B组比较，不良反应的比例明显高于其他两组，有统计学意义上的差异(p < 0.05)；母婴结局方面(包括分娩方式、新生儿Apgar评分) 3组无差异(p > 0.05)。结论：0.115%罗哌卡因复合布托啡诺20 μg/ml用于硬膜外分娩镇痛起效快、镇痛效果好、不良反应少。

Abstract: Objective: To compare the effect of epidural analgesia with 0.115% ropivacaine combined with bu-torphanol or fentanyl on the outcome of mother and infant. Methods: 90 singleton and first- term parturient women who were willing to accept labor analgesia were randomly divided into 3 groups. Group A: 0.115% ropivacaine combined with butorphanol 20 μg/ml; Group B: 0.115% ropivacaine combined with fentanyl 1.5 μg/ml; Group C: 0.115% ropivacaine for epidural labor analgesia. The onset time of analgesia (VAS ≤ 3), the time of first PCA and the total amount of medication were ob-served and compared among the three groups, the changes of vital signs, adverse reactions, Apgar score of newborn and mode of delivery were recorded and compared among the 3 groups. Results: The VAS scores of the three groups were significantly lower than those before analgesia (VAS score ≥ 7 before analgesia, VAS score ≤ 3 after analgesia) (p < 0.05); compared with Group B and C, Group A had faster onset time of analgesia, shorter initial time of PCA, less effective times of PCA, lower total dose of PCA (p < 0.05), higher Ramsay sedation score, and higher side effects; compared with Group A and group B, the proportion of adverse reactions in group C was significantly higher than that in the other two groups (p < 0.05). There was no difference in maternal and infant outcomes (including mode of delivery and Apgar score) among the 3 groups (p > 0.05). Conclusion: 0.115% ropivacaine combined with butorphanol 20 μg/ml is effective and safe for epidural labor analgesia with less adverse reactions.