不同剂量硬膜外分娩镇痛对产后尿潴留的影响

Effect of Different Doses of Epidural Labor Analgesia on Postpartum Urinary Retention

目的探讨不同剂量下罗哌卡因联合舒芬太尼硬膜外分娩镇痛方案安全性和对产后尿潴留的影响。方法选取2018年5月-2019年5月本院妇产科收治的拟行硬膜外分娩镇痛下自然分娩的初产妇80例,随机分为甲方案组和乙方案组,每组40例,甲方案组产妇采取0.1%罗哌卡因+0.3μg/mL舒芬太尼的硬膜外分娩镇痛方案,乙方案组产妇采取0.075%罗哌卡因+0.5μg/mL舒芬太尼的硬膜外分娩镇痛方案,比较两组产妇的视觉模拟评分(VAS)、尿潴留、其他不良反应和新生儿出生后Apgar评分。结果结果显示,两组的镇痛时间差异无统计学意义;与此同时,在子宫颈开口3 cm时(T0)、分娩镇痛后30 min(T1)、宫颈口开口10 cm时(T2)、分娩即刻(T3)和分娩后2 h时(T4)5个时间点的疼痛评分差异均无统计学意义;但麻醉后的其他时间点的疼痛评分与T0比较,均具有统计学意义。甲方案组尿潴留发生率为5.00%,低于乙方案的20.00%,差异具有统计学意义(χ^2=4.114,P=0.043)。两组产妇分娩的新生儿在出生后l min、5 min和10 min时的Apgar评分差异均无统计学意义(P>0.05)。结论两种剂量的分娩镇痛方案均可有效缓解分娩疼痛,但在0.1%罗哌卡因+0.3μg/mL舒芬太尼剂量下产后尿潴留的发生风险更小。

Objective To investigate the safety of ropivacaine combined with sufentanil for epidural labor analgesia at different doses and its effect on postpartum urinary retention. Methods 80 cases of primipara undergoing natural delivery under epidural labor analgesia were selected from May 2018 to May 2019 in Qinzhou Hospital of Traditional Chinese Medicine. The subjects were randomly divided into group A and group B, 40 casesin each group. The group A was given 0.1% ropivacaine + 0.3 ug/mL sufentanil epidural labor analgesia. In group B, 0.075% ropivacaine plu 0.5 ug/mL sufentanil was used for epidural labor analgesia. Visual analogu score(VAS), urinary retention, other adverse reactions and postnatal Apga score were compared between the two groups. Results The results showed that there was no significant difference in the time of analgesia between the two groups. At the same time, there were no significant differences in pain scores at 3 cm of cervical opening(T0), 30 min after labor analgesi(T1), 10 cm after cervical opening(T2), immediately after delivery(T3) and2 h after delivery(T4), but there were significant differences in pain score at other time points after anesthesia compared with T0. The incidence o urinary retention in group A was 5.00%, which was lower than that in group B(20.00%). The difference was statistically significant(χ2 = 4.114, P =0.043). There was no significant difference in Apgar scores between the two groups at 1, 5 and 10 minutes after birth(P > 0.05). Conclusion Both dose of ropivacaine combined with sufentanil for epidural labor analgesia can effectively relieve labor pain, but the risk of postpartum urinary retention i lower at 0.1% ropivacaine + 0.3 ug/mL sufentanil.