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氯普鲁卡因与罗哌卡因用于硬膜外自控分娩镇痛的疗效比较

Comparison of the efficacy of chloroprocaine and ropivacaine for epidural labor analgesia

摘要:

目的 比较氯普鲁卡因与罗哌卡因用于硬膜外自控分娩镇痛的疗效及安全性.方法 选择86例自愿接受无痛自然分娩的产妇为研究对象,其中43例应用氯普鲁卡因硬膜外自控镇痛(氯普鲁卡因组),另43例应用罗哌卡因硬膜外自控镇痛(罗哌卡因组).比较两组产妇产前即刻和用药后10 min、20 min、40 min、80 min的疼痛程度(VAS评分)、下肢运动神经阻滞程度(MBS评分)、胎心率(FHR)及宫缩持续时间;比较两组产妇第一、二、三产程时间及胎儿产出后1 min、5 min、10 min新生儿Apgar评分;观察两组产妇用药过程中和用药后不良反应发生情况.结果 氯普鲁卡因组阵痛后10 min VAS评分为(2.10±1.02)分,与罗哌卡因组[(4.31±1.13)分]差异有统计学意义(t=4.565,P<0.05);氯普鲁卡因组镇痛后20 min MBS评分[(0.24±0.03)分]较罗哌卡因组[(0.11±0.04)分]高,差异有统计学意义(t=4.126,P<0.05).氯普鲁卡因组出现神经损伤4例,多于罗哌卡因组的1例,差异有统计学意义(x2=4.263,P<0.05).结论 氯普鲁卡因与罗哌卡因用于硬膜外自控分娩镇痛均有优越的疗效,且临床疗效基本相同.氯普鲁卡因具有见效较快的优点,但是在用药20 min左右时间段内该药物会导致下肢运动神经阻滞程度较大,且有损伤神经的危险,可根据孕妇自身情况选择用药.

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Objective To observe and compare the efficacy and safety of chloroprocaine and ropivacaine for epidural labor analgesia.Methods 86 cases of voluntary acceptance of maternal painless natural childbirth were selected in the study.43 cases were given chloroprocaine epidural analgesia (chloroprocaine group),and the other 43 cases were given ropivacaine epidural analgesia (ropivacaine group).The pain (VAS score),lower limb motor block degree(MBS score),fetal heart rate(FHR) and contractions duration of maternal prenatal and medication immediately after 10min,20min,40min,80min were compared between two groups.The first,second and third stage of labor and fetal output after 1 min,5min,10min Apgar score were compared.The incidence of adverse events were observed.Results In the chloroprocaine group,the 10min VAS score was (2.10 ± 1.02),which was significantly lower than (4.31 ± 1.13) in the ropivacaine group (t =4.565,P < 0.05).In the chloroprocaine group,analgesia 20min MBS score was (0.24 ± 0.03),which was significantly higher than (0.11 ± 0.04) in the ropivacaine group (t =4.126,P < 0.05).In the chloroprocaine group,4 cases occurred nerve injury,which was more than the ropivacaine group (1 case),the difference was statistically significant (x2 =4.263,P < 0.05).Conclusion Chloroprocaine and ropivacaine for epidural labor analgesia have superior efficacy and the clinical efficacy is similar.Chloroprocaine has the advantage of quick results,but the medication about 20min time period that the drug might lead to a greater degree of lower limb motor block,and has the risk of nerve injury,pregnant women can choose according to their medication.

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