导乐仪镇痛与不同剂量罗哌卡因蛛网膜下腔镇痛对产程和母婴预后的影响对比

Comparative Effect Between Analgesia of Doula Instrument and Different Doses of Ropivacaine for Subarachnoid Analgesia on the Labor Progress and Prognosis of Mother and Child in Delivery

目的对比导乐仪镇痛与不同剂量罗哌卡因蛛网膜下腔镇痛对产程和母婴预后的影响。方法选择医院2016年12月至2017年12月行分娩镇痛初产妇300例,根据随机数字表法分为A组(行神经和肌肉刺激仪镇痛)与B组(行腰硬联合麻醉分娩镇痛),各150例;按给药剂量不同将B组分为B1组(蛛网膜下腔给予2μg罗哌卡因)和B2组(蛛网膜下腔给予3μg罗哌卡因),各75例。结果 B1组和B2组镇痛满意率均高于A组(P <0. 05),B1组与B2组间无明显差异(P> 0. 05); A组和B1组第1产程、第2产程时间均短于B2组(P <0. 05),A组与B1组间无差异(P> 0. 05); 3组产妇第3产程时间比较均无差异(P> 0. 05); B1组和B2组缩宫素使用率低于A组(P <0. 05),B1组与B2组间无明显差异(P> 0. 05); 3组产妇术后出血量比较均无差异(P> 0. 05); B1组和B2组Bromage评分均低于A组(P <0. 05),B1组与B2组间比较无明显差异(P> 0. 05); 3组产妇新生儿Apgar评分比较均无差异(P> 0. 05); 3组产妇不良反应比较无差异(P> 0. 05)。结论在产程潜伏期行椎管内分娩镇痛,蛛网膜下腔给予2μg的罗哌卡因对产妇子宫收缩干扰小,产程影响小,运动阻滞轻,建议应用于分娩潜伏期要求镇痛的产妇。

Objective To compare the effect between analgesia of Doula instrument and different doses of ropivacaine for subarachnoid analgesia on the labor progress and prognosis of mother and child in delivery.Methods Totally300primiparas undergoing labor analgesia in our hospital from December2016to December2017were selected.According to the random number table method,the primiparas were divided into group A(analgesia with nerve and muscle stimulator)and group B(analgesia with combined spinal and epidural anesthesia for labor),150cases in each group,and then the cases in group B were randomly divided into group B1(subarachnoid2μg ropivacaine)and group B2(subarachnoid3μg ropivacaine),75cases in each group.Results The analgesia satisfaction rates of group B1and group B2were higher than that of group A(P<0.05),but there was no significant difference between group B1and group B2(P>0.05).The labor time in the first stage and the second stage of group A and group B1was shorter than that of group B2(P<0.05),but there was no significant difference between group A and group B1(P>0.05).There was no significant difference in the labor time of the third stage among the three groups(P>0.05).The usage of oxytocin in group B1and group B2was lower than that of group A(P<0.05),but there was no significant difference between group B1and group B2(P>0.05).There was no significant difference in the amount of bleeding after cesarean section among the three groups(P>0.05).The Bromage scores of group B1and group B2were lower than that in group A(P<0.05),but there was no significant difference between group B1and group B2(P>0.05).There was no significant difference in the neonatal Apgar score among three groups(P>0.05).There was no significant difference in the incidence of maternal adverse reactions among the three groups(P>0.05).Conclusion During labor latency,spinal and epidural blocking labor analgesia(SEPLA)was performed,and subarachnoid injection of2μg ropivacaine has little effect on uterine contraction of puerpera,little influence on birth process and mild motor block.It is recommended for puerpera who need labor analgesia during latent period.