罗哌卡因联合地塞米松对硬膜外分娩镇痛的影响

Effect of ropivacaine combined with dexamethasone on epidural labor analgesia

目的比较罗哌卡因与罗哌卡因联合地塞米松用于硬膜外分娩镇痛的疗效。方法选取2017年8月~2018年8月于我院经阴道分娩的初产妇60例,当产妇宫颈扩张≥4 cm,且变薄50%时被随机分为两组:A组(n=30)予硬膜外0.125%罗哌卡因,总体积为15 mL,B组(n=30)予硬膜外0.125%罗哌卡因联合地塞米松4 mg,总体积15 mL。在首次要求止痛时,通过硬膜外导管给药10 mL 0.125%罗哌卡因,每小时用8 mL 0.125%罗哌卡因进一步镇痛。主要观察指标是硬膜外镇痛时间,次要观察指标包括:阻滞前和阻滞后15 min视觉模拟量表疼痛评分、使用罗哌卡因总量、Apgar评分、脐静脉pH值、产妇满意度和副作用。结果 B组的平均镇痛时间长于A组,差异有统计学意义(P<0.05)。A组的罗哌卡因总需求量高于B组,差异有统计学意义(P<0.05)。与阻滞前相比,阻滞后A组和B组的VAS均低于阻滞前,差异有统计学意义(P<0.05)。B组T10平均感觉阻滞起效时间长于A组,差异有统计学意义(P<0.05)。B组的最高感觉阻滞平均时间长于A组,差异有统计学意义(P<0.05)。两组在最高感觉阻滞水平上无统计学差异,两组间无运动阻滞发生率。两组在血流动力学、疼痛评分、新生儿结局、产妇满意度和并发症方面无统计学差异。结论硬膜外罗哌卡因联合地塞米松在治疗分娩疼痛时延长硬膜外镇痛时间,血流动力学稳定,母婴不良反应有限。

Objective To compare the efficacy of ropivacaine and dexamethasone on epidural labor analgesia. Methods60 primiparas who underwent vaginal delivery in our hospital from August 2017 to August 2018 were enrolled. They were randomly divided into two groups: group A(n=30) was treated with epidural 0.125% ropivacaine, total volume15 mL and group B(n=30) was treated with epidural 0.125% ropivacaine plus dexamethasone 4 mg, total volume 15 mL. At the first request for analgesia, 10 mL of 0.125% ropivacaine was administered via an epidural catheter and further analgesia was achieved with 8 mL of 0.125% ropivacaine per hour. The primary outcome measure was epidural analgesia time. Secondary observations included visual analog scale pain score, total ropivacaine use, Apgar score, umbilical vein pH, maternal satisfaction and side effects at pre-and post-blocking 15 minutes. Results The mean analgesia time in group B was longer than that in group A, and the difference was statistically significant(P<0.05). The total demand for ropivacaine in group A was higher than that in group B, and the difference was statistically significant(P<0.05). Compared with that before the block, the VAS of group A and group B was lower after block, and the difference was statistically significant(P<0.05). The onset time of T10 mean sensory block in group B was longer than that in group A, and the difference was statistically significant(P<0.05). The mean time of maximum sensory block in group B was longer than that in group A, and the difference was statistically significant(P<0.05). There was no significant difference in the level of maximum sensory block between the two groups, and there was no incidence of motor block in the two groups. There were no statistically significant differences in hemodynamics, pain scores, neonatal outcomes, maternal satisfaction and complications between the two groups. Conclusion Epidural dexamethasone combined with ropivacaine prolongs the time of epidural analgesia in the treatment of labor pain, with hemodynamic stability, and limited maternal and child adverse reactions.