目的 探討鹽酸羅哌卡因與布比卡因在無痛分娩中的鎮(zhèn)痛效果對比及對產(chǎn)婦應(yīng)激反應(yīng)影響。方法 收集寶雞市第五人民醫(yī)院2015年6月-2016年12月收治的自愿采用分娩鎮(zhèn)痛的產(chǎn)婦210例，隨機數(shù)字表法分為A組和B組，同時同期收取105例不愿采取無痛分娩產(chǎn)婦為對照組，A組給予羅哌卡因聯(lián)合芬太尼麻醉，B組給予布比卡因聯(lián)合芬太尼麻醉，觀察鎮(zhèn)痛效果及對產(chǎn)婦應(yīng)激反應(yīng)的影響。結(jié)果 麻醉前VAS評分組間差異無統(tǒng)計學(xué)意義；麻醉后與麻醉前相比，A和B組VAS評分均降低，對照組升高，差異具有統(tǒng)計學(xué)意義（P<0.05）；且A和B組VAS評分明顯低于對照組，差異具有統(tǒng)計學(xué)意義（P<0.05）；A組評分低于B組，但是差異無統(tǒng)計學(xué)意義。經(jīng)過評估兩組MBS評分差異無統(tǒng)計學(xué)意義。1、5 min Apgar評分在3組間差異無統(tǒng)計學(xué)意義；與1 min Apgar評分相比，3組5 min Apgar評分均升高，差異具有統(tǒng)計學(xué)意義（P<0.05）。B組和對照組血糖均升高，差異具有統(tǒng)計學(xué)意義（P<0.05）；麻醉前A組和B組皮質(zhì)醇水平高于對照組，差異具有統(tǒng)計學(xué)意義（P<0.05）；麻醉后B組高于對照組，A組低于對照組，A組低于B組水平，差異具有統(tǒng)計學(xué)意義（P<0.05）。麻醉前A組和B組胰島素/血糖比值低于對照組，麻醉后A組和B組水平高于對照組，A組低于B組水平，差異具有統(tǒng)計學(xué)意義（P<0.05）。結(jié)論 產(chǎn)婦分娩鎮(zhèn)痛采用羅哌卡因自控輸注效果顯著，并且可以減輕產(chǎn)婦應(yīng)激反應(yīng)，值得臨床推薦。

Objective To investigate analgesic effect of ropivacaine and bupivacaine in painless childbirth and response to maternal stress. Methods The voluntary labor analgesia maternal 210 cases in The Fifth People's Hospital of Baoji City from June 2015 to December 2016 were randomly divided into A group and B group. 105 cases collected during the same period to take maternal painless childbirth as the control group, A group was given ropivacaine combined with fentanyl anesthesia, B group received bupivacaine combined with fentanyl anesthesia, observe the analgesic effect and the effect on maternal stress response. Results The difference between the groups before anesthesia score VAS was not statistically significant. After anesthesia compared with before anesthesia, A group and B VAS scores were reduced, the control group increased, the difference was statistically significant (P<0.05). And VAS in A and B group was significantly lower than the control group, the difference was statistically significant (P<0.05). After evaluation, there was no statistical difference between the two groups in MBS score. 1, 5 min, Apgar scores were not statistically significant in the 3 groups. Compared with the 1 min Apgar score, Apgar scores in 3 and 5 min were increased, the difference was statistically significant (P<0.05). Blood glucose levels in B group and control group were increased (P<0.05). Cortisol levels in group A and group B before anesthesia were higher than the control group (P<0.05); After anesthesia, cortisol levels in group B was higher than the control group, A group was lower than that in group B (P<0.05). Before anesthesia, the ratio of insulin/blood glucose in the A group and the B group was lower than that in the control group (P<0.05), and that in A group and B group after anesthesia was higher than that in the control group, and the level of A group was lower than that of the B group (P<0.05). Conclusion maternal analgesia with patient-controlled infusion effect, and can reduce maternal stress reaction, it is worthy of recommendation.