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低浓度大容量罗哌卡因联合舒芬太尼用于产科硬膜外分娩镇痛的安全性和有效性

Safety and efficacy of low-concentration and high-volume ropivacaine combined with sufentanil for epidural analgesia during labor in obstetrics
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摘要 目的探讨0.08%罗哌卡因联合0.2 mcg/mL舒芬太尼用于产科硬膜外分娩镇痛的安全性和有效性。方法回顾性分析2018年9月-2023年1月在广州和睦家医院硬膜外分娩镇痛下行顺产的单胎足月妊娠产妇80例,根据2020年10月前后分娩镇痛药物配方不同将产妇分为对照组(n=40)和观察组(n=40),对照组使用0.15%罗哌卡因联合2 mcg/mL芬太尼,观察组使用0.08%罗哌卡因联合0.2 mcg/mL舒芬太尼,收集所有产妇分娩期间的临床资料,记录和比较2组产妇分娩镇痛实施前(T_(0)),实施后15 min(T_(1))、30 min(T_(2))、1 h(T_(3))、2 h(T_(4))、分娩当时(T_(5))的宫缩时视觉模拟评分(VAS),以及分娩时改良Bromage运动评分,总产程时间,爆发性疼痛发生次数,相关不良反应,新生儿娩出后的1、5、10 min阿普加评分(Apgar)等。结果观察组的T_(1)、T_(2)、T_(3)、T_(4)、T_(5)的宫缩时VAS评分以及爆发性疼痛发生比例均低于对照组,差异均有统计学意义(H=7.92、12.30、12.73、33.68、31.37,χ^(2)=17.80,P均<0.05)。观察组每小时罗哌卡因用量为(12.53±1.94)mg,低于对照组的(13.87±2.71)mg,差异有统计学意义(t=-2.54,P=0.01)。观察组改良Bromage运动评分均为0,低于对照组。观察组与对照组不良反应发生率(10.0%vs.7.5%)比较差异无统计学意义(P=0.69)。观察组新生儿娩出后1 min Apgar评分为10分,高于对照组9分,差异有统计学意义(t=3.67,P<0.05)。2组新生儿娩出后5、10 min Apgar评分均为10分。结论低浓度大容量罗哌卡因联合舒芬太尼用于产科硬膜外分娩镇痛是安全有效的。 Objective To evaluate the safety and efficacy of 0.08%ropivacaine combined with 0.2 mcg/mL sufentanil for epidural analgesia during labor in obstetrics.Methods A total of 80 full-term cephalic singleton pregnant women who received epidural analgesia in the Guangzhou United Family Hospital between September 2018 to January 2023 were selected for this study.The participants were divided into control group(n=40)and observation group(n=40)based on the different formulations of labor analgesia drugs administered before and after October 2020.Observation group received a combination of 0.08%ropivacaine and 0.2 mcg/mL sufentanil,while control group received a combination of 0.15%ropivacaine and 2 mcg/mL fentanyl.Clinical data of parturient women were collected and compared between two groups,including visual analogue scale(VAS),pain score at pre-analgesia(T_(0)),15 min(T_(1)),30 min(T_(2)),1 h(T_(3)),and 2 h(T_(4))after epidural puncture,as well as the time of delivery(T_(5)).Additional measurements included Bromage motion score for modified exercise,total labor time,occurrence of breakthrough pain,adverse event,Apgar scores at 1,5 and 10 minutes post-delivery.Results The VAS scores of T_(1),T_(2),T_(3),T_(4),T_(5) and the incidence of fulminant pain in the observation group were lower than those in the control group;the differences were significant(H=7.92,12.30,12.73,33.68,31.37,χ^(2)=17.80;all P<0.05).The dosage of ropivacaine in the observation group was(12.53±1.94)mg per hour,which was lower than(13.87±2.71)mg per hour in the control group,the difference was significant(t=-2.54,P=0.01).The modified Bromage motor score of the observation group was 0,lower than that of the control group.There was no significant difference in the incidence of adverse events between the two groups(10.0%vs.7.5%,P=0.69).Apgar score was 10 at 1 min after delivery in the observation group,which was significantly higher than that of 9 in the control group(t=3.67,P<0.05).Apgar score was 10 at 5 and 10 min after delivery in both groups.Conclusion The combination of low-concentration and high-volume ropivacaine with sufentanil was both safe and effective for obstetric epidural analgesia.
作者 周焕勉 郭静宜 文静 方海宏 赵一凡 刘卫锋 ZHOU Huanmian;GUO Jingyi;WEN Jing;FANG Haihong;ZHAO Yifan;LIU Weifeng(Department of Anesthesiology,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong 510515,China;Department of Anesthesiology,Guangzhou United Family Hospital,Guangzhou,Guangdong 510335,China;Department of Infection Management,Guangzhou First People's Hospital,Guangzhou,Guangdong 510180,China)
出处 《热带医学杂志》 CAS 2023年第9期1193-1197,共5页 Journal of Tropical Medicine
基金 广东省自然科学基金(2021A1515010002) 广州卫生健康科技项目(20221A011056)
关键词 罗哌卡因 舒芬太尼 芬太尼 分娩镇痛 硬膜外阻滞 Ropivacaine Sufentanil Fentanyl Labor analgesia Epidural
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