国际麻醉学与复苏杂志   2020, Issue (2): 8-8
    
低浓度罗哌卡因用于分娩镇痛时对产力的影响
潘永英, 王青宁, 区信栩, 李品, 宋兴荣1()
1.广州市妇女儿童医疗中心
Effects of a low concentration of ropivacaine on maternal labor force during labor analgesia
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摘要:

目的 探讨低浓度罗哌卡因用于分娩镇痛时对产程中子宫肌和腹肌收缩力的影响。 方法 选择拟自然分娩初产妇150例,采用随机数字表法将接受分娩镇痛的100例初产妇分为0.062 5%罗哌卡因组(罗哌卡因组,50例)和0.062 5%左布比卡因组(左布比卡因组,50例),选取同期经阴道分娩未采取镇痛措施的初产妇50例作为对照组。记录产妇的年龄、BMI、孕周、剖宫产率、钳产率、第一产程时间、第二产程时间、缩宫素使用率、产后2 h出血量。分别于分娩镇痛开始时(T1)、分娩镇痛后15 min(T2)、分娩镇痛后30 min(T3)和分娩镇痛后45 min(T4)4个时点采用VAS评分评估产妇疼痛情况。记录肌电图(electromyography, EMG)爆发波能量参数[包括爆发波次数、爆发波持续时间、均方根(root mean square, RMS)、功率及峰值频率],综合评估产妇子宫肌和腹肌收缩力。 结果 3组产妇在年龄、BMI、孕周、剖宫产率、钳产率及产后2 h出血量方面比较,差异无统计学意义(P>0.05);与对照组和罗哌卡因组比较,左布比卡因组第一产程时长和第二产程时长延长,缩宫素使用率明显升高(P<0.05)。在T2、T3、T4时点,与对照组比较,罗哌卡因组和左布比卡因组产妇VAS评分明显降低(P<0.05)。第一产程中,与对照组比较,罗哌卡因组和左布比卡因组产妇子宫肌EMG的RMS明显降低(P<0.05);与对照组和罗哌卡因组比较,左布比卡因组产妇的EMG功率明显降低(P<0.05)。第二产程中,与对照组和罗哌卡因组比较,左布比卡因组产妇子宫肌EMG的爆发波持续时间明显延长(P<0.05);与对照组比较,罗哌卡因组和左布比卡因组的RMS明显降低(P<0.05)。 结论 0.062 5%的罗哌卡因用于硬膜外分娩镇痛时能达到良好的镇痛效果,对产妇产力无明显影响,且不延长产程。

关键词: 罗哌卡因; 左布比卡因; 分娩镇痛; 肌电图; 产程
Abstract:

Objective To investigate the effects of a low concentration of ropivacaine on the contraction of the uterine and abdominal muscles during labor analgesia. Methods One hundred and fifty primiparous women who expected to have a natural birth were selected. Then, 100 primiparous women were divided into two groups according to the random number table method: a 0.062 5% ropivacaine group (group ropivacaine, n=50) and a 0.062 5% levobupivacaine group (group levobupivacaine, n=50). Meanwhile, 50 primiparous women who did not take analgesic measures during vaginal delivery were set as a control group. Their age, body mass index (BMI), gestational age, cesarean section rate, forceps delivery rate, the duration of the first and second stages of labor, the rate of oxytocin use, and blood loss 2 h after delivery were recorded. The maternal pain was evaluated on the basis of Visual Analogue Scale (VAS) scores at the beginning of labor analgesia (T1), 15 min after labor analgesia (T2), 30 min after labor analgesia (T3) and 45 min after labor analgesia (T4). Then, the parameters of electromyography (EMG) burst wave energy were recorded, including the number and duration of burst waves, root mean square (RMS), and power and peak frequency, so as to comprehensively evaluate the contraction of the uterine and abdominal muscles. Results There was no significant difference in age, BMI, gestational age, cesarean section rate, forceps delivery rate, and blood loss 2 h after delivery among the three groups (P>0.05). Compared with groups control and ropivacaine, group levobupivacaine presented significantly extended duration of the first and second stages of labor, and marked increases in the rate of oxytocin use (P<0.05). Compared with group control, groups ropivacaine and levobupivacaine showed obviously decreased maternal VAS scores at T2, T3, and T4 (P<0.05). In the first stage of labor, compared with group control, the RMS of uterine muscle EMG in groups ropivacaine and levobupivacaine significantly reduced (P<0.05), compared with groups control and ropivacaine, the maternal power of group levobupivacaine significantly reduced (P<0.05). In the second stage of labor, compared with groups control and ropivacaine, group levobupivacaine presented significantly extended duration of EMG burst wave in the uterine muscle (P<0.05), compared with group control, groups ropivacaine and levobupivacaine showed significantly reduced RMS (P<0.05). Conclusions The use of 0.062 5% ropivacaine for epidural analgesia can achieve good effects, without significant impacts on maternal labor force, and does not prolong labor stage.

Key words: Ropivacaine; Levobupivacaine; Labor analgesia; Electromyography; Labor stage