小剂量罗哌卡因蛛网膜下腔-硬膜外联合阻滞用于高原地区产妇分娩镇痛的效果研究

The effect of spinal anesthesia with low dose ropivacaine for labor analgesia in highland

目的研究小剂量罗哌卡因蛛网膜下腔硬膜外联合阻滞用于高原地区产妇分娩镇痛的效果。方法选择高原地区产妇100例，足月、初产，按随机数字表法分为两组（每组50例）：分娩镇痛组（A组）和对照组（B组）。A组于宫口开到3cm时蛛网膜下腔给予0．1％罗哌卡因3mg，继而硬膜外腔置管接患者自控镇痛泵，胎儿娩出后2h拔除镇痛泵。B组不接受分娩镇痛。分别记录麻醉前（T0）和麻醉后5min（T1）、10min（T2）、30min（T3）时两组产妇的BP、HR、VAS评分和Bromage分级情况。记录各组产程时间、分娩方式、缩宫素使用情况、产妇满意度评分、产后24h出血量和新生儿1min、5minApgar评分。结果两组产妇各时点BP和HR差异无统计学意义（P〉0．05）。A组T1时VAs评分显著低于T0时（P〈0．05）。两组产妇产程时间、产后24h出血量和新生儿1min、5minApgar评分差异无统计学意义（P〉0．05）。B组转剖宫产率和缩宫素使用率均大于A组（P〈0．05）。B组满意度评分低于A组（P〈0．05）。结论高原地区产妇接受小剂量罗哌卡因分娩镇痛可快速、有效缓解产痛，对产程和新生儿影响小。

Objective To evaluate the effect of combined spinal epidural anesthesia with low dose ropivacaine for labor analgesia in highland. Methods One hundred of primiparas who were at full term and in spontaneous labor in highland were assigned randomly in two groups（n=50）： labor analgesia group（group A） and control group（group B）. In group A, 0.1% ropivacaine 3 ml were given in spinal when the cervical dilation were 3 cm, then patient controlled epidural analgesia pump were placed in epidural. And the patient controlled epidural analgesia pump were withdrawn when the fetus were delivered. In group B, primiparas did not accepted any labor analgesia. BP, HR and the scores of VAS and Bromage were determined before anesthesia （T0） and at 5 rain （T1）, 10 min（T2）, 30 min（T3） after anesthesia in two groups. Duration of labor, method of delivery, oxytocin dose, maternal satisfaction and amount of bleeding after birth were recorded. The Apgar scores of the neonates were recorded at 1, 5 rain alter birth. Results BP, HR, duration of labor, amount of bleeding after birth, the Apgar scores of the neonates of two groups did not show significant difference（P〉0.05）. The VAS score was less in the labor analgesia group at 5 min after anesthesia than the score before anesthesia（P〈0.05）. Cesarean section rate and oxytoein doses in group B were significantly higher than that of group A （P〈0.05）. Maternal satisfaction rate in group A was significantly higher than rate in group B （P〈0.05）. Conclusions Labor analgesia in highland results in less pain rapidly and maternal satisfaction remains high without negative effect on duration of labor and fetus.