剖宫产术后不同镇痛模式对新生儿神经和适应能力的影响

Effects of different analgesia modes after cesarean section on neonatal neurobehavioral scores and adaptive capacity scores

目的探讨剖宫产术后不同镇痛模式对新生儿神经和适应能力的的影响。方法选取2013年8月至2014年10月的132例单胎、妊娠足月的产妇作为研究对象,所有产妇剖宫产术中均采用持续硬膜外的麻醉方式,按照随机平均的方法,根据术后镇痛模式的不同,将其分为4组。前3组定为观察组,第1组:采用0.2%的甲磺酸罗哌卡因;第2组:采用0.2%甲磺酸罗哌卡因加用3μg/h的芬太尼;第3组采用0.2%甲磺酸罗哌卡因加用80μg/h的吗啡;对照组:仅在疼痛时给予盐酸哌替啶进行肌内注射。观察组使用负荷量为5 ml的0.2%的甲磺酸罗哌卡因。监测并记录术后第2、6、24及48 h的疼痛视觉模拟(VAS)分数,并观察四组新生儿术后1 min和5 min的A-gar评分及术后24 h内新生儿的神经和适应能力(NACS)分数。结果观察组中第1组的术后第24 h和48 h的VAS分数均明显高于第2组和第3组,差异有统计学意义(P<0.05),对照组的术后各时间点的VAS分数均明显高于第2组和第3组,具有显著性差异(P<0.05),且术后的第2 h和6 h的VAS分数明显高于第1组,差异有统计学意义(P<0.05);四组新生儿术后1 min和5 min的A-gar评分差异无统计学意义(P>0.05);4组新生儿的NACS分数差异无统计学意义(P>0.05)。结论甲磺酸罗哌卡因复合芬太尼或吗啡用于持续硬膜外镇痛对剖宮产产妇术后镇痛均有效,且对新生儿的神经和适应能力无不良影响。

Objective To observe the effects of different analgesia modes after cesarean section on neonatal neurobehavioral scores and adaptive capacity scores（ NACS）. Methods One hundred and twenty- eight parturients after cesarean section with continuous epidural anesthesia who admitted into our hospital from August 2013 to October 2014 were enrolled in the study. These parturients were randomly divided into 4 groups according to different analgesia modes after cesarean section,with 32 parturients in each group. The first three groups were observation groups and the last group was control group. The parturients in group 1 received epidural analgesia with 0. 2% ropivacaine mesylate,and group 2 with 0. 2%ropivacaine mesylate plus 3μg / h fentanyl,group 3 with 0. 2% ropivacaine mesylate plus 80μg / h morphine,however,the parturients in group 4 received intramuscular injection with pethidine hydrochloride only during pain. The visual analog scales（ VAS） were recorded on 2h,6h,24 h,48h after operation,moreover,Apgar scores on 1min and 5 min after operation and NACS on 20 h after operation were observed and recorded for the 4 groups. Results The VAS scores on 24 h and 48 h after operation in group 1 were significantly higher than those in group 2 and group 3（ P 〈0. 05）. The VAS scores in control group in different time points after operation were significantly higher than those in group 2 and group 3（ P 〈0. 05）,moreover,the VAS scores in control group on 2h and 6h after operation were significantly higher than those in group 1（ P 〈0. 05）. There were no significant differences in Apgar scores on 1min and 5 min after operation and NACS on 20 h after operation among 4 groups（ P〉 0. 05）. Conclusion Ropivacaine mesylate combined with fentanyl or morphine has obvious analgesia effects on parturients after cesarean section,moreover,which has no adverse effects on neonatal neurobehavioral scores and adaptive capacity scores.