熊玮 祝彩霞 牛刚 黄雄庆

【摘要】目的探讨罗哌卡因对行会阴侧切缝合术的经阴道分娩产妇术后镇痛效果和安全性。方法选择经阴道分娩且行会阴侧切缝合术的306例足月单胎初产妇，随机分为利多卡因组和罗哌卡因组，每组各153例产妇，在会阴侧切缝合术前分别应用20 ml 02%利多卡因和20 ml 02%罗哌卡因进行会阴阻滞麻醉，应用疼痛视觉模拟评分法（VAS）评估产妇术后疼痛程度，观察2组的不良反应发生情况。 结果2组产妇的年龄、分娩孕周、麻醉分级、顺产率和新生儿出生体质量比较差异均无统计学意义（P均>005）。罗哌卡因组产妇在产后0、2、6、12、24 h的VAS分值均低于利多卡因组（P均<0001）。2组产妇的低血压、恶心呕吐、感觉异常、口干发生率比较差异均无统计学意义（P均>005）。结论罗哌卡因用于会阴侧切缝合术的阻滞麻醉，有利于减轻产妇的术后疼痛，且安全性高。

【关键词】罗哌卡因；会阴侧切缝合术；产妇；术后镇痛

Effect of ropivacaine on postoperative analgesia in primiparous women after lateral episiotomyXiong Wei，Zhu Caixia， Niu Gang， Huang Xiongqing Department of Anesthesiology， the First Affiliated Hospital of Sun Yatsen University， Guangzhou 510080， China

Corresponding author， Huang Xiongqing， Email： huangxq2163@163com

【Abstract】ObjectiveTo explore the analgesic effect and adverse events of ropivacaine upon postoperative pain in pregnant women undergoing lateral episiotomy MethodsA total of 306 primiparous women with fullterm singleton pregnancy undergoing vaginal delivery and lateral episiotomy were randomly assigned into the lidocaine （n=153） and ropivacaine groups （n=153） Prior to lateral episiotomy， perineal nerve block anesthesia was delivered by 20 ml of 02% lidocaine and ropivacaine between two groups The degree of postoperative pain was assessed by visual analogue scale （VAS） The incidence of postoperative adverse events was observed ResultsAge， gestational week， classification of anesthesia， vaginal delivery rate and neonatal birth weight did not significantly differ between two groups （all P>005） In the ropivacaine group， the VAS scores at 0， 2， 6， 12 and 24h after labor were significantly lower compared with those in the lidocaine group （all P<0001） The incidence of hypotension， nausea， vomiting， abnormal sensation and dry mouth did not significantly differ between two groups （all P>005） ConclusionApplication of ropivacaine in the block anesthesia after lateral episiotomy can mitigate postoperative pain and yield less adverse events compared with lidocaine

【Key words】Ropivacaine； Lateral episiotomy； Puerpera； Postoperative analgesia

會阴侧切缝合术是阴道分娩过程中常需要的助产手段，其中钳产助产均需要使用会阴侧切缝合术。传统的会阴侧切缝合术使用02%利多卡因进行会阴阻滞麻醉，产妇产后伤口疼痛严重，影响产后休息、延长产后恢复时间，导致尿潴留和便秘发生率升高，因此在术后24 h内多需要追加曲马多或哌替啶。罗哌卡因常用于剖宫产术中硬膜外阻滞，术后24 h镇痛效果较好[1]。本研究主要比较应用02%罗哌卡因与02%利多卡因行会阴阻滞麻醉对会阴侧切缝合术产妇的术后镇痛效果，同时研究其不良反应发生情况。

对象与方法

一、研究对象

选择2016年1月至12月在我院住院阴道分娩、行会阴侧切缝合术的足月单胎初产妇共306例。病例……