罗哌卡因和布比卡因分娩镇痛中胎儿α1-酸性糖蛋白浓度的比较

THE COMPARISON OF FETAL ALPHA-1-ACID GLYCOPROTEIN CONCENTRATION BETWEEN ROPIVACAINE AND BUPIVACAINE FOR LABOUR PAIN RELIEF

摘要:

目的通过测定脐血中α1-酸性糖蛋白(alpha-1-acid glycoprotein,AAG)浓度,来比较罗哌卡因和布比卡因分娩镇痛中对胎儿的毒性作用.方法选择42例产前检查估计能从阴道自然分娩的头位、单胎足月初产妇.随机分为三组,A组为罗哌卡因-芬太尼组;B组为布比卡因-芬太尼组;C组为未行分娩镇痛对照组,每组各14例.分娩镇痛采用病人自控硬膜外镇痛(patient-controlledepidural analgesia,PCEA),PCEA剂量为基础注药速率为6ml/h,冲击量均为2ml,锁定时间均为10min.采用"速率散射比浊法"测定脐血中α1-酸性糖蛋白浓度,进行脐血血气分析,进行胎儿的Apgar评分和SpO2检测,视觉模拟镇痛评分法(VAS)评定产妇疼痛程度,用下肢运动神经阻滞评分法(MBS)评定产妇运动神经阻滞程度.结果两组产妇的镇痛效果无显著差异.罗哌卡因组脐血α1-酸性糖蛋白浓度和pH值明显高于布比卡因组(P＜0.05).罗哌卡因组1分钟胎儿Apgar评分和胎儿血氧饱和度明显高于布比卡因组(P＜0.05).布比卡因组对运动神经阻滞大于罗哌卡因组.结论在分娩镇痛时,罗哌卡因对胎儿毒性低于布比卡因.

Abstract:

Objective: To compare the fetal toxicity between ropivacaine and bupivacaine in laboring patient by measuring AAG concentration in umbilical blood.Methods: 42 primiparous parturients were randomly divided into ropivacaine group(A),bupivacaine group(B) and the control group(C).Parturients received 0.1% ropivacaine-fentanyl(Group A) or 0.1% bupivacaine-fentanyl(Group B).Basal infusion was 6ml/h with patient-control bolus 2ml/h,lockout time 10 min.The parturients reported pain intensity on a visual analogue scale(VAS).Degree of motor disorder was measured by modified Bromage score(MBS).The duration of labor and the mode of delivery were recorded.AAG concentration was measured by using speed dispersion turbidimetry.Umbilical blood gas,fetal Apgar and SpO_2 were examined.Results: The number of parturients reporting good or excellent analgesia was similar between the two groups.There was no difference in VAS between the two groups(P>0.05).The parturients in Group B had more severe motor disorder than Group A.AAG concentration and pH in Group A and C in umbilical blood were significantly higher than Group B.The fetal Apgar and SpO_2 in Group A and C were higher than Group B.Conclusion: The fetal toxicity of ropivacaine was less than bubivacaine in labor analgesia.