黄唯

【摘要】 目的：探讨罗哌卡因联合舒芬太尼硬膜外麻醉对可行走无痛分娩镇痛的效果研究。方法：选取笔者所在医院足月妊娠产妇134例作为研究对象，按其分娩镇痛方式分为对照组和研究组，对照组61例采用常规分娩；研究组73例采用可行走无痛分娩。采用视觉模拟评分法（VAS）于产妇活跃期（第一产程）、第二产程及第三产程评价比较产妇疼痛状况，采用改良的Bromage分级（MBS）评价运动神经阻滞状况。结果：对照组剖宫产率高于研究组，差异有统计学意义（P<0.05）；对照组在第一产程、第二产程、第三产程的VAS评分均高于研究组，差异有统计学意义（P<0.05）；对照组第一产程时长、第二产程时长均长于研究组，差异有统计学意义（P<0.05）；两组下肢運动神经阻滞情况比较，差异有统计学意义（P<0.05）。结论：可行走式无痛分娩对产妇镇痛效果显著，可显著降低产妇各个产程的疼痛程度及缩短生产时间，产后并发症较少。

【关键词】 罗哌卡因； 舒芬太尼； 硬膜外麻醉； 可行走无痛分娩

doi：10.14033/j.cnki.cfmr.2017.13.009 文献标识码 B 文章编号 1674-6805（2017）13-0020-03

【Abstract】 Objective：To explore the analgesic effect of Ropivacaine combined with Sufentanil in epidural anesthesia on walkable painless labor.Method：134 cases of maternal pregnancy were selected and randomly divided into control group and study group.61 cases of control group were treated with conventional delivery，while 73 cases of study group were treated with walkable on painless labor.The visual analogue scale and improved Bromage classification score were respectively used to evaluate and compare the condition of pain and motor nerve block of maternal，at the first to third stage of labor.Result：The rate of cesarean section of control group was higher than that of study group，and the difference was statistically significant（P<0.05）.The visual analogue scale score of control group was higher at the first to third stage of labor，and the difference was statistically significant（P<0.05）.The labor time of control group were longer at the first and second stage of labor，and the difference was statistically significant（P<0.05）.Compared the condition of motor nerve block of lower limbs between the two groups，the difference was statistically significant（P<0.05）.Conclusion：The effect of ambulatory labor analgesia on maternal effect is significant，it can significantly reduce the pain degree of parturition and shorten the production time，and the postpartum complications are fewer.

【Key words】 Ropivacaine； Sufentanil； Epidural anesthesia； Painless childbirth walking

First-authors address：Maternity and Child Healthcare Hospital of Changning District in Shanghai，Shanghai 200051，China

分娩可给孕产妇带来巨大的疼痛，目前尚无有效药物可在镇痛的同时保证分娩的安全性且无痛[1]。随着医学的飞速发展，人们理念的改变，无痛分娩迅速兴起，硬膜外自控镇痛在分娩镇痛中受到了广泛关注，其对产妇的活动能力不产生影响，被称为可行走式无痛分娩[2]。可行走式无痛分娩具有良好的镇痛效果，可显著降低产妇各产程的疼痛感觉[3]。硬膜外阻滞仍是目前临床应用最广泛、技术最成熟的分娩镇痛方式[4]。

分娩镇痛常选择低浓度局部麻醉药复合小剂量阿片类镇痛药[5]。罗哌卡因是一种新型酰胺类局麻药，治疗过程中对心脏及神经的毒性较低，另外低浓度罗哌卡因具有显著降低感觉、运动神经阻滞分离等优点，在可行走硬膜外分娩镇痛中得到大规模应用。研究发现极低浓度（0.08%）罗哌卡因复合舒芬太尼用于硬膜外分娩镇痛具有良好的临床效果及安全性[6]。……