不同硬膜外镇痛时机对产妇腰-硬联合阻滞后分娩镇痛效果的影响

Effect of different timing of epidural analgesia on labour analgesia after combined spinal-epidural block in parturient

目的:探讨不同硬膜外镇痛时机对产妇腰-硬联合阻滞后分娩镇痛效果的影响。方法:选取足月初产妇160例,均于宫口开至2~3 cm行腰-硬联合阻滞。采用随机数字表法将产妇分为3 min组、30 min组、60 min组和90 min组,各40例。各组分别在腰-硬联合阻滞后于3 min、30 min、60 min、90 min持续硬膜外给药。比较2组产程时间、新生儿Apgar评分、脐动脉血气分析、自控镇痛(PCA)例数及次数、催产素使用率、罗哌卡因补救剂量与总剂量及不良反应情况。结果:4组运动神经阻滞程度均为0级。4组镇痛前和镇痛后30 min、2 h、4 h及宫口全开时收缩压、舒张压、心率差异均无统计学意义(P>0.05)。4组产程时间、新生儿Apgar评分、催产素使用率、PCA使用次数及脐动脉酸碱度、剩余碱、氧分压及二氧化碳分压水平差异无统计学意义(P>0.05)。60 min组、90 min组需要PCA例数均高于3 min组及30 min组(P<0.05)。60 min组、90 min组罗哌卡因补救剂量、总剂量均高于3 min组及30 min组(P<0.05)。4组治疗过程中不良反应发生率差异均无统计学意义(P>0.05)。结论:产妇腰-硬联合阻滞后30 min内予以硬膜外镇痛可减少自控镇痛次数和罗哌卡因使用剂量。

Objective:To explore the effect of different timing of epidural analgesia on labour analgesia after combined spinal-epidural block in parturient.Methods:One hundred and sixty cases of full-term primipara were selected,and treated with combined spinal-epidural block when the uterine orifice was opened to 2-3 cm.The parturients were divided into 3 min group,30 min group,60 min group and 90 min group(40 cases in each group)by random number table method,which received continuous epidural administration at 3 min,30 min,60 min and 90 min after combined spinal epidural block,respectively.The labour duration,neonatal Apgar score,umbilical artery blood gas analysis,times of using patient-controlled analgesia(PCA),use rate of oxytocin,rescue dose and total dose of ropivacaine and adverse reactions were compared between the two groups.Results:The degree of motor nerve block in four groups was grade 0.There were no significant differences in systolic blood pressure,diastolic blood pressure and heart rate between the four groups before analgesia,30 min after analgesia,2 h after analgesia,4 h after analgesia and when uterine orifice being fully opened(P>0.05).There were no significant differences in labour duration,neonatal Apgar score,use rate of oxytocin,use times of PCA,umbilical artery pH,base excess,partial pressure of oxygen and partial pressure of carbon dioxide among the four groups(P>0.05).The times of using PCA in 60 min group and 90 min group was higher than that in 3 min group and 30 min group(P<0.05).The rescue dose and total dose of ropivacaine in 60 min group and 90 min group were higher than those in 3 min group and 30 min group(P<0.05).There was no significant difference in the incidence of adverse reactions among the four groups(P>0.05).Conclusions:Epidural analgesia within 30 min after combined spinal-epidural block can reduce the times of using PCA and dosage of ropivacaine.