研究产程活跃期患者自控硬膜外分娩镇痛(patient－controlled epidural analgesia, PCEA)的应用效果及对母儿结局的影响。

对2004年2月至2006年2月要求分娩镇痛的190例单胎、足月临产的初产妇，采用前瞻性研究方法，将其随机分为两组：镇痛Ⅰ组采用0.2%罗哌卡因(98例)，镇痛Ⅱ组采用0.1%布比卡因(92例)，均辅以芬太尼2 μg/ml，首次负荷量为10 ml，采用电子镇痛泵调节维持给药量为5 ml/h，宫口开全后停用麻醉剂，选取同期未采用任何镇痛方法分娩的100例为对照组(分组征得患者本人的知情同意)。

镇痛Ⅰ组、镇痛Ⅱ组的孕妇分娩镇痛效果均良好，两组比较，差异无显著意义(P>0.05)。分娩镇痛能缩短产程活跃期时间，降低剖宫产率，与对照组比较，差异有显著意义(P<0.05)。镇痛Ⅰ组与镇痛Ⅱ组相比，使用阴道器械的助产率低(P<0.05)，对产妇产后出血无影响(P>0.05)，对胎儿和新生儿无不良影响。

患者自控硬膜外分娩镇痛对母亲及胎儿安全有效，罗哌卡因不影响子宫收缩力和其他产力，更有利于阴道分娩。

To study the analgesic effect and motor block of ropivacaine with bupivacaine in laboring parturient using patient-controlled epidural analgesia(PCEA).

From February 2004 to February 2006, 190 pregnant women were divided into 2 groups randomly. 0.2% ropivacaine was given to group Ⅰ (98 cases), and 0.1% bupivacaine was given to group Ⅱ (92 cases). Fentanyl (2 μg/ml), was added into local anesthetic solution for each group. A loading dose of 10 ml was given. Patient-controlled epidural analgesia was set. The infusion stopped when full uterus was opening.

Effective labor analgesia provided 2 groups with shortening labor course than the contrast group(P<0.05). Compared with the contrast group, there were significant differences on uterine-incision delivery in group Ⅰ and group Ⅱ(P<0.05). Labor analgesia could shorten labor active course and decline the rate of uterine-incision delivery.There was no adverse effect on puerperant postnatal blood loss. The use of oxytocin and instrumental labor in group Ⅰ were less than that of group Ⅱ(P<0.05). There was no adverse effect on infants.

Patient-controlled epidural analgesia is an effective and safe way in labor course. Ropivacaine does not affect uterine contraction and force of labor. Ropivacaine is more profit for vagina delivery.