左旋布比卡因加芬太尼用于硬膜外阻滞分娩镇痛.docVIP

　　【摘要】 目的 观察硬膜外低浓度左旋布比卡因与芬太尼配伍，用于分娩镇痛的临床效果，以及对产程、产妇、新生儿的影响。方法 根据自愿要求将100例产妇分为镇痛组和对照组。镇痛组于子宫口开大3～4cm时硬膜外给药，首次剂量:0.15%左旋布比卡因+1μg/ml芬太尼10～15ml，然后视产程进展和宫缩痛情况追加给药。对照组第二产程行会阴阻滞麻醉。结果 （1）观察组的镇痛效果明显优于对照组（P 0.01）;（2）镇痛组产妇生命体征和新生儿阿氏评分与对照组比较差异无显著性（P 0.05）;（3）产妇运动能力、产程时间比较差异无显著性（P 0.05）。结论 低浓度左旋布比卡因复合芬太尼硬膜外给药用于分娩镇痛效果良好，是较安全、有效的分娩镇痛药物配伍方法。 　　fentanyl on peridural anesthesia labor analegsia Huang Xiaopeng，Xiao Xiaoshan，Wang Baoping，et al. The Second People Hospital of Guangdong Province，Guangzhou510317. 【Abstract】 Objective To explore the clinical effect of low concentration Levobupivacaine with Fentanyl on peridual anesthesia labor analegsia and its influence on labor course，parturient and newborns.Methods Divided100volunteers into analgesia group and control group.When uterine orifice was3-4cm，drug analgesia group on epidural space.Initial dose was0.15%Levobupivacaine plus1ug/ml Fentanyl10-15ml，then increased dose gradually accordˉing to labor course and the extent of pain of uterine contraction.The control group，perineum block anesthesia was done on second stage of labor.Results The analgesia effect of analgesia group was better than that of control group（P 0.01）.There was no significant difference of parturient’s vital sign and newborns’Apgar score between the two groups.There was no significant difference of sports ability，labor course between the two groups.Conclusion The compatibility of low concentration Levobupivacaine with Fentanyl has much effect on painless labor and is safe and effective. 　　Key words Levobupivacaine Fentanyl labor analgesia peridural anesthesia 我院自2003年8月采用0.15%左旋布比卡因复合小剂量芬太尼行硬膜外分娩镇痛，观察其镇痛效果以及对产妇和胎儿的影响，现报告如下。 　　1 资料与方法 1.1 一般资料 自愿镇痛组与对照组各50例，100例产妇ASAⅠ～Ⅱ级，产前检查心电图无异常，无阴道试产禁忌证，镇痛组无硬膜外穿刺禁忌证。两组年龄、身高、体重、孕周差异均无显著性（P 0.05）。 1.2 方法 观察组子宫口开大3～4cm时，在持续心电监护下进行硬膜外穿刺（L 2～3 ），向头端置管3～4cm，回抽无脑脊液和血液后，给予0.15%左旋布比卡因+lμg/ml芬太尼10～15ml，根据产程进展、子宫收缩情况、产痛程度追加4～6ml/h，子宫口开全后停止给药。胎儿娩出后，产妇调整体位成45°，单次注入产后镇痛液15ml，用于会阴侧切口的缝合。对照组按产科常规，于第二产程行会阴阻滞麻醉。 1.3 产痛程度与活动能力评分法 产痛程度采用视觉模拟评分法 ［1］