To Study Nitrous Oxide Inhalation And Various Concentration Ropivacaine In Epidural For Labor Analgesia

5.三组分娩镇痛方法对胎儿和新生儿无影响.6.根据MLAC原则,lmg/ml罗哌卡因+3ug/ml芬太尼用于硬膜外分娩镇痛效果确切,是一合理的药物浓度选择.ObjectiveTo study the pain relief effectiveness of the patient controlled epidural analgesia of Various Concentration Ropivacaine and inhalation of nitrous oxide for labor analgesia, and to measure the influences on the mothers and infants.MethodsWe selected120cases of primipara with a vertex pregnancy and vaginal trial production conditions, single fetal head position,no obvious cephalopelvic disproportion without obstetric complications and contra of intraspinal anesthesia with fetal monitoring reactive.The cases were randomized into four groups:Group A(n=30) patients received epidural infusion of0.2%ropivacaine combined with3ug/ml fentanyl2ml/h.Group B(n=30)patients received epidural infusion of0.1%ropivacaine combined with3ug/ml fentanyl2ml/h.Group C(n=30)patients received nitrous oxide inhalation.Group D(n=30)patients only received psychological counseling without any drug analgesia. Maternal measured variables included blood pressure,heart rate, saturation of blood oxygen,fetal heart rate(FHR). The intensity of pain and motor function was assessed by modified bromage score(MBS). Taked notes of delivery mode, duration of labor,Apgar scores and Neurological Adaptive Capacity Scores(NACS) of neonates, the level of serum prolactin,gas analysis of umbilical vein blood. Results were analysised by SPSS13.0.Results:1.Analgesic efficacy:Group A(27cases), Group B (27cases) and group C (17cases) were effective. Compared with the control group, three labor analgesia all showed good pain relief(P<0.05).Group A and B are better than group C (P<0.05).2.Duration of labor,type of delivery, postpartum hemorrhage, serum PRL concentration and the initial time of lactation of corresponding labor women:Compared with the control group,the active phase of group A,B and C were significantly faster (P<0.05).The second and third stage of labor has no significant difference.in four group. The second stage of labor in group A was a little longer than the others, but not significant (P>0.05). The C-sect rate in group A,B,C were lower than group D (P<0.05). Compared with group C, the C-sect rate in group A and B were lower(P<0.05). The rates of instrumental deliveries in four groups were not statistically significant differences(P>0.05).There were no significant difference of serum PRL concentration, the initial time of lactation in four groups(P>0.05).At the end of the third stage of labor, the PRL level of analgesic group offered increased tendency than that of control group,but there were no significant difference(P>0.05). 3. The neonates result during labor analgesia:Apgar scores at1min and5min were not statistically significant differences in the four groups.NACS at15min,2hour and24hour,the cases of high score(≥35score)in the four groups were not statistically significant difference. The blood gas of the umbilical vein were all in normal range and had no statistically significant difference.4. Vital signs and adverse drug reactionThere were no significant difference in vital signs among three analgesic groups after labor analgesia. Crura tiny lack of power were discovered in group A for4cases, nausea and vomiting were discovered in group C for2cases. There were skins pruritus in each group A and B for1cases but recovery after labor. Other adverse drug reactions were not discovered.Conclusions:1.Epidural infusion of0.2%ropivacaine with3ug/ml fentanyl or0.1%ropivacaine with3ug/ml fentanyl all provided effective analgesia during labor.2.The inhalation of nitrous oxide can safely provide effective labor analgesia. It was easy and simple to handle.The price was moderate.It was suit for clinical use in community hospital.But,the effection was inferior to the epidural labor analgesia.3.Epidural labor analgesia can shorten the duration of the active stage of labor and reduces the C-sect rate.Group A and B are better than group C.4.Three groups of labor analgesia has no influence on vital signs, saturation of blood oxygen of puerperal,serum PRL concentration and the initial time of lactation. There were no marked change in postpartum hemorrhage and using of ocytocin.5.Fetus and neonates is unaffected by labor analgesia in three groups.6.By MLAC,epidural infusion of0.1%ropivacaine with3ug/ml fentangl can provid effective analgesia during labor. It was a suitable concentration in labor epidural analgesia.