目的:探讨芬太尼联合罗哌卡因硬膜外麻醉用于无痛分娩的临床疗效及对产程的影响.方法:选取116例产妇随机分为对照组和观察组各58例,两组均采用硬膜外麻醉,其中对照组穿刺后注入0.1%的罗哌卡因,观察组注入0.5μg/ml的芬太尼和0.1%的罗哌卡因的混合溶液,观察两组的麻醉效果、主要指标变化及产程变化.结果:观察组麻醉效果优良率(94.8%)高于对照组(81.0%),第一产程时间(6.1±2.1h、1.7±0.4h)短于对照组(7.8±2.3h、2.4±0.6h);麻醉后起效时间(4.3±1.2min)、阻滞时间(1.8±0.9 min)、持续时间(5.3±1.6)min均优于对照组(13.6±2.5 min、24.6±2.8 min、2.5±0.6 min)(均P<0.05);出血量(198.6±40.8ml)与对照组(195.2±41.7ml)比较无差异(P>0.05);新生儿体重(4.25±1.64kg)与对照组(4.18±1.59kg)比较无差异(P>0.05);窒息发生率(5.2%)及胎儿宫内窘迫发生率(5.2%)低于对照组(12.1%、13.8%)(P<0.05).结论:芬太尼联合罗哌卡因硬膜外麻醉用于无痛分娩,可改善麻醉的主要指标,提高麻醉效果,缩短产程,具有较好的临床应用意义.
Objective:To investigate the clinical efficacy of fentanyl combined with ropivacaine for epidural anesthesia in painless labor and its influence on labor process.Methods:116 parturients were randomly divided into control group and observation group (58 cases in each group).The parturients in the two groups were all treated with epidural anesthesia,the parturients in control group were injected 0.1% ropivacaine after the puncture,and the parturients in observation group were injected a mixture of 0.5 g/ml of fentanyl and 0.1% ropivacaine.The anesthetic effect,the changes of main index of parturients,and situation of labor were compared between the two groups.Results:The anesthesia excellent rate (94.8%) of parturients in observation group was significant higher than that of parturients in control group (81%).The time of the first stage of labor (6.1 ± 2.1h,1.7 ± 0.4h) of parturients in observation group was significant shorter than that of parturients in control group (7.8 ± 2.3h,2.4 ± 0.6h).The time of anesthesia onset (4.3± 1.2min),block time (1.8± 0.9 min) and duration (5.3 ± 1.6 min) of parturients in observation group were significant better than those of parturients in control group (13.6±2.5 min,24.6±2.8 min,2.5±0.6 min,respectively) (P< 0.05).But bleeding valume of parturients in observation group (198.6±40.8ml) had no significant difference when that compared to parturients in control group (195.2±41.7ml) (P>0.05).The neonatal weight in observation group (4.25±1.64kg) had also no significant difference when compared to control group (4.18±1.59kg) (P >0.05).The incidence of neonatal asphyxia (5.2 %) and the incidence of fetal distress (5.2 %) in observation group were significant lower than those of parturients in control group (12.1% and 13.8%) (P <0.05).Conclusion:Fentanyl combined with ropivacaine forepidural anesthesia in painless labor can improve the anesthetic effect and can shorten the labor process,which has good clinical significance.