右美托咪定联合罗哌卡因程控硬膜外间歇脉冲注入分娩镇痛对产妇产程和母婴情况影响

Study on Effects of Epidural Programmed Pulsed Injection Labor Analgesia of Dexmedetomidine Combined with Ropivacaine on Maternal Stages of Labor and Maternal-infant Situation

目的探讨右美托咪定联合罗哌卡因程控硬膜外间歇脉冲注入(programmed intermittent epidural bolus, PIEB)分娩镇痛对产妇产程和母婴情况的影响。方法选取给予右美托咪定联合罗哌卡因分娩镇痛的产妇98例,根据硬膜外输注方式不同将其分为PIEB组(47例)和连续硬膜外输注(continuous epidural infusion, CEI)组(51例)两组。比较两组不同时间疼痛程度、产程时间、出血量、镇痛满意情况、不良反应发生情况、母亲角色适应情况,以及新生儿出生后1和5 min Apgar评分情况。结果镇痛前、镇痛后1 h、镇痛后2 h、宫口开全时及分娩时,两组组内视觉模拟评分法(visual analogue score, VAS)评分总体比较差异均有统计学意义(P<0.01)。镇痛后1 h、镇痛后2 h、宫口开全时和分娩时,PIEB组VAS评分均低于镇痛前;镇痛后2 h、宫口开全时和分娩时,PIEB组VAS评分均低于镇痛后1 h,差异有统计学意义(P<0.01)。镇痛后1 h、镇痛后2 h、宫口开全时及分娩时,CEI组VAS评分均低于镇痛前,差异有统计学意义(P<0.01)。镇痛后1 h、镇痛后2 h、宫口开全时及分娩时,CEI组VAS评分随着时间延后逐渐升高,组内不同时间VAS评分两两比较差异均有统计学意义(P<0.01)。镇痛后2 h、宫口开全时和分娩时,PIEB组VAS评分均低于CEI组,差异有统计学意义(P<0.01)。PIEB组第一产程时间及出血量短于或少于CEI组,差异有统计学意义(P<0.01)。分娩结束24 h后镇痛满意度和分娩结束72 h后母亲角色适应率PIEB组高于CEI组,差异有统计学意义(P<0.05)。两组分娩镇痛后住院期间总不良反应发生率以及新生儿出生后1和5 min Apgar评分比较差异均无统计学意义(P>0.05)。结论右美托咪定联合罗哌卡因PIEB较CEI对产妇具有良好分娩镇痛效果,能缩短产程、减少出血量、提升镇痛满意度、改善母亲角色适应能力,且安全性较好。

Objective To investigate the effects of dexmedetomidine combined with ropivacaine for labor analgesia by programmed intermittent epidural bolus(PIEB) on maternal stages of labor and maternal-infant situation. Methods Ninety-eight puerperae who were given dexmedetomidine combined with ropivacaine for labor analgesia were selected. According to the different methods of epidural infusion, they were divided into PIEB group(n=47) and continuous epidural infusion(CEI) group(n=51). The pain level at different time points, stages of labor, blood loss, analgesia satisfaction, occurrence of adverse reactions, maternal role adaptation and neonatal Apgar score at 1 min and 5 min after birth were compared between the two groups. Results Before analgesia, at 1 h and 2 h after analgesia, at full opening of uterine orifice and at delivery, there was a statistically significant difference in the score of visual analogue scale(VAS) between the two groups(P<0.01). At 1 h and 2 h after analgesia, at full opening of uterine orifice and at delivery, the VAS scores in PIEB group were lower than those before analgesia(P<0.01). At 2 h after analgesia, at full opening of uterine orifice and at delivery, the VAS scores in PIEB group were lower than those at 1 h after analgesia(P<0.01). At 1 h and 2 h after analgesia, at full opening of uterine orifice and at delivery, the VAS score in CEI group was lower than that before analgesia(P<0.01). At 1 h after analgesia, at 2 h after analgesia, at full opening of uterine orifice and at delivery, the VAS score in CEI group was gradually increased with time, which at any two time points was statistically different(P<0.01). At 2 h after analgesia, at full opening of uterine orifice and at delivery, the VAS scores in PIEB group were significantly lower than those in CEI group(P<0.01). The first stage of labor and blood loss in PIEB group were shorter or less than those in CEI group(P<0.01). The analgesia satisfaction at 24 h after the end of delivery and maternal role adaptation rate at 72 h after the end of delivery in PIEB group were higher than those in CEI group(P<0.05). There were no significant differences in the total incidence rates of adverse reactions and neonatal Apgar scores at 1 and 5 min after birth between the two groups(P>0.05). Conclusion Dexmedetomidine combined with ropivacaine by PIEB for labor analgesia has good effects, which can shorten the stages of labor, reduce blood loss, and improve the analgesia satisfaction and the maternal role adaptation. In addition, it has good safety.