全产程分娩镇痛及对血管紧张素Ⅱ和皮质醇的影响

Labor analgesia during all stages and its influences on angiotensinⅡand cortisol in parturient

目的研究全产程硬膜外分娩镇痛的效果及对应激反应的影响。方法300例无产科并发症及硬膜外麻醉禁忌证的单胎足月初产妇,随机分为3组。Ⅰ组为全产程组,当进入产程宫口<3 cm时进行镇痛;Ⅱ组为活跃期组,当宫口≥3 cm时进行镇痛。两组硬膜外均给予0.1%罗哌卡因与0.5μg/ml舒芬太尼混合液11～13 ml,45 min后行硬膜外自控镇痛,药物为上述混合液,背景速度8 ml/h,单次剂量2 ml,锁定时间15 min。宫口开全时停药,胎儿娩出后再开启PCA;Ⅲ组为对照组,不用任何镇痛药物。观察VAS评分和运动阻滞分级,记录产程时间、分娩方式、产后出血量、新生儿Apgar评分。测定产妇血中血管紧张素Ⅱ和皮质醇含量。结果Ⅰ组与Ⅱ、Ⅲ组比较,在潜伏期VAS评分明显降低(P<0.05),Ⅰ、Ⅱ组与Ⅲ组比较,缩宫素使用率明显增高(P<0.05)。三组间比较产程时间、剖宫产率、器械助产率、产后出血量及新生儿Apgar评分比较差异无统计学意义(P>0.05)。Ⅲ组血管紧张素Ⅱ和皮质醇的变化最大,其次为Ⅱ组,Ⅰ组变化最小。结论全产程分娩镇痛对比传统分娩镇痛方式,镇痛效果确切,对产程、剖宫产率及新生儿并无不良影响,可抑制应激反应。

Objective To investigate the effect of epidural analgesia on labor and the influences of stress reaction during all labor stages. Methods Three hundred single birth, full term primiparas without obstetrical complications and epidural anesthesia contraindications were randomly divided into 3 groups. Group Ⅰ （all labor stages group）, giving analgesia when get into birth process, os uteri 〈3cm;Group Ⅱ （active stage group）： giving analgesia when os uteri≥3cm. Both groups were given 0. 1% ropivacaine and 0.5μg/ml sulfentanyl 11- 13 ml into epidural space. Patient controlled analgesia was started 45 mins later, background speed 8ml/h, single close 2ml,locking time 15 min. Group Ⅲ （control group） ：any analgesics were not used. VAS, the degree of motor block,labor time, labor style,volume of blood loss and Apgar score were recorded. Angiotensin Ⅱ and cortisol in parturient blood were determined. Result Compared with group Ⅱ ,Ⅲ , VAS was lower significantly during latency stage in group Ⅰ （P〈0. 05）; compared with group Ⅲ, the dosage of oxytocin was higher significantly in group Ⅰ , Ⅱ（P〈0.05）. There were no significant differences among the three groups in labor time, cesarean section ratio, assist labor ratio with apparatus, volume of blood loss and neonate Apgar seore（P〉0.05）. The changes of angiotensin Ⅱ and cortisol in group Ⅲ were the biggest,next were in group Ⅱ ,smallest in group Ⅰ. Conclusion Compared with traditional labor analgesia style,analgesic effect is more definitive during all labor stages,and have no harmful effects on labor stages,cesarean section ratio and neonates. Also the stress reaction can be inhibited .