不同分娩镇痛方案对产妇围产期心理状态影响的比较

Comparison of effects of different labor analgesia regimens on perinatal mental state of parturients

目的比较舒芬太尼混合罗哌卡因与单纯罗哌卡因硬膜外分娩镇痛对产妇围产期心理状态的影响。方法选择2016年4月至2019年4月在本院分娩、要求实施分娩镇痛的初产妇389例,ASA分级Ⅰ或Ⅱ级,孕周≥37周,年龄25~45岁,采用随机数字表法分为2组:罗哌卡因组(R组,n=193)采用1.5%罗哌卡因进行硬膜外分娩镇痛;罗哌卡因混合舒芬太尼组(RS组,n=196)采用1%罗哌卡因混合0.5μg/ml舒芬太尼进行硬膜外分娩镇痛。于分娩镇痛诱导完成后30 min时、产后42 d时采用爱丁堡抑郁量表(EPDS)、社会支持感知多维度量表(MSPSS)、母乳喂养自我简式量表(BSES)评价产妇心理状况。结果最终RS组161例、R组157例完成研究。与RS组比较,R组产后42 dEPDS评分降低,BSES评分升高(P<0.05),MSPSS评分差异无统计学意义(P>0.05)。结论与罗哌卡因硬膜外分娩镇痛相比,舒芬太尼混合罗哌卡因硬膜外分娩镇痛对产妇的心理状况的不良影响较显著。

Objective To compare the effects of sufentanil mixed with ropivacaine and ropivacaine alone for peripartum analgesia on perinatal mental state of parturients.Methods Three hundred and eighty-nine primiparous acquiring labor analgesia in our hospital from April 2016 to April 2019,of American Society of Anesthesiologists physical status Ⅰ or Ⅱ,at≥37 weeks of gestation,aged 25-45 yr,were divided into 2 groups using a random number table method:ropivacaine group(R group,n=193)and ropivacaine mixed with sufentanil group(RS group,n=196).Epidural labor analgesia was performed with 1.5%ropivacaine in group R.Epidural labor analgesia was performed with 1% ropivacaine mixed with 0.5μg/ml sufentanil in group RS.The Edinburgh depression scale(EPDS),multidimensional social support perception scale(MSPSS)and breast-feeding self-brief scale(BSES)were used to evaluate the maternal psychological status at 30 min after labor analgesia induction and 42 days after delivery.Results One hundred and sixty-one patients completed the study in group RS and 157 patients in group R.Compared with group RS,the EPDS score was significantly decreased,and the BSES score was increased at 42 days after delivery(P<0.05),and no significant change was found in MSPSS score in group R(P>0.05).Conclusion Compared with epidural labor analgesia with ropivacaine,epidural labor analgesia with sufentanil mixed with ropivacaine has a marked adverse effect on the perinatal mental state of parturients.