ZHU Yuan,XIONG Ya,LI Hongyu,et al.Pain relief effects of ropivacaine for perineal pain during vaginal delivery under epidural labor analgesia: a doubleblind randomized controlled trial[J].J Third Mil Med Univ,2019,41(07):691-695.

罗哌卡因浸润麻醉对椎管内分娩镇痛下自然分娩后会阴疼痛镇痛效果的随机对照研究(/HTML )




Pain relief effects of ropivacaine for perineal pain during vaginal delivery under epidural labor analgesia: a doubleblind randomized controlled trial
ZHU Yuan XIONG Ya LI Hongyu WANG Dan CHEN Yan LU Kaizhi NING Jiaolin

Department of Anesthesiology, Department of Gynecology and Obstetrics, First Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, 400038, China

罗哌卡因利多卡因麻醉 局部自然分娩镇痛 产科  
ropivacaine lidocaine anesthesia local natural childbirth analgesia obstetrical
R614.32; R714.3; R971.2

目的 比较罗哌卡因和利多卡因对椎管内分娩镇痛下自然分娩后会阴疼痛的镇痛效果。方法 纳入2016年2月至2017年4月我院产科74名经阴道分娩并接受椎管内分娩镇痛的足月单胎产妇,其中初产妇60例,经产妇14例。采用随机数字表法分为罗哌卡因组和利多卡因组(n=37)。在会阴切开术或会阴修补术前进行0.75%罗哌卡因或1%利多卡因会阴局部浸润。用视觉模拟评分法(visual analogue score,VAS)对分娩过程中及分娩后会阴疼痛进行评价分级,并对产妇满意度进行评价。结果 在注药后1 min (33 vs 26例,P=0.043),产后3 h (31 vs 20例,P=0.006)、4 h (27 vs 11例,P<0.001)、6 h (20 vs 0例,P=0.030),罗哌卡因组VAS为0的产妇多于利多卡因组,差异具有统计学意义(P<0.05)。分娩后坐立(11 vs 0例,P<0.001)、排尿(22 vs 3例,P<0.001)和睡觉(32 vs 24例,P=0.030)时,罗哌卡因组VAS评分为0的产妇人数均多于利多卡因组。罗哌卡因组对分娩镇痛满意的产妇(评价为非常满意和满意)多于利多卡因组 (36 vs 29例,P=0.013)。罗哌卡因组和利多卡因组新生儿Apgar评分、脐动静脉pH值、碱剩余、乳酸含量、二氧化碳分压和血红蛋白含量组间比较差异均无统计学意义。结论 罗哌卡因会阴浸润麻醉较之于利多卡因能提供更快和更长时间的镇痛,可显著提高椎管内分娩镇痛下自然分娩产妇的满意度。


Objectives To compare the effects of ropivacaine versus lidocaine infiltration on the pain relief for perineal pain of puerpera undergoing vaginal delivery. Methods This is a prospective, randomized, doubleblind study. Seventyfour puerperae with term singleton fetus undergoing vaginal delivery under epidural labor analgesia were enrolled into this study in the maternity center of our hospital from February 2016 to April 2017. Among them, 60 were primipara and 14 were transpartum women. They were randomly allocated into ropivacaine group and lidocaine group (n=37). Before planned episiotomy or perineal repair, 0.75 % ropivacaine or 1 % lidocaine infiltration was injected to them. Visual analog scale (VAS) was used to rank the perineal pain grade. Moreoven, the puerpera’s  satisfaction was evaluated. ResultsThere were more puerpera with VAS score equal to 0 in the ropicavaine group than the lidocaine group at 1 min (33 vs 26, P=0.043) after injection, and 3 (31 vs 20, P=0.006), 4 (27 vs 11, P<0.001) and 6 h (20 vs 0, P=0.030) after delivery. The proportion of puerpera with VAS score of 0 in ropivacaine group was larger than that in the lidocaine group when they were sitting up (11 vs 0, P<0.001), urinating (22 vs 3, P<0.001) and sleeping (32 vs 24, P=0.030) after delivery. Maternal satisfaction (very satisfied or satisfied) with labor analgesia in the ropivacaine group was better than that in the lidocaine group (36 vs 29, P=0.013). There were no significant differences in Apgar score, umbilical artery and venous pH value, BE, lactic acid content, partial pressure of carbon dioxide and hemoglobin content between the 2 groups. Conclusion Ropivacaine perineal infiltration can provide faster and longer analgesia than lidocaine. It can significantly improve the satisfaction of vaginal delivery women with epidural labor analgesia.


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更新日期/Last Update: 2019-04-05