罗哌卡因+芬太尼腰硬联合分娩镇痛的效果及对胎儿血流、细胞因子的影响

The Effect of Ropivacaine and Fentanyl Spinal Epidural Combined Labor Analgesia and its Influence on Fet al Blood Flow and Cytokines

目的 探究罗哌卡因与芬太尼腰硬联合镇痛方式对分娩镇痛效果以及胎儿血流、细胞因子的作用。方法 选取2020年7月-2021年8月深圳市龙华区人民医院分娩的单胎头位初产妇120例,以分娩镇痛选择的不同分为观察组与对照组,每组各60例,对照组选择无镇痛自然分娩,观察组选择罗哌卡因与芬太尼腰硬联合分娩镇痛,对比两组产妇分娩过程的血清去甲肾上腺素(NE)、脐动脉血心纳素(ANP)、内皮素1(ET-1)、血气分析以及产程时间、剖宫产率。结果 观察组产妇分娩活跃期NE水平相比对照组明显降低(P<0.05),第一产程、第二产程、第三产程时间均相比对照组明显缩短(P<0.05),剖宫产率相比对照组明显降低(P<0.05),两组新生儿的脐带动脉血pH值、PO_(2)、PCO_(2)、ANP与ET-1指标以及1min Apgar评分比较,差异均无统计学意义(P>0.05),观察组胎儿脐带动脉血Lac相比对照组明显降低(P<0.05)。结论 罗哌卡因与芬太尼腰硬联合分娩镇痛的效果较为理想,能够有效缓解分娩过程中产妇机体的疼痛递质,同时对胎儿血液供应、细胞因子无抑制作用,安全性较好。

Objective To explore the effect of ropivacaine and fentanyl combined with spinal epidural analgesia in labor and the changes of fet al blood flow and cytokines.Methods A total of 120 singleton primiparas who gave birth in Shenzhen Longhua District People’s Hospital from July 2020 to August 2021 were divided into observation group and control group with 60 cases each.The control group chose to give birth naturally without analgesia for observation.In the observation group,ropivacaine and fentanyl combined with spinal epidural analgesia were selected to compare the serum norepinephrine (NE),umbilical artery blood atrial natriurectic factor (ANP) and endothelin 1 (ET-1),blood gas analysis and labor time,cesarean section rate during the delivery process of the two groups.Results The NE level of the pregnant women in the observation group was lower than that of the control group (P<0.05).The first,second and third stages of labor were shorter than those of the control group (P<0.05),and the cesarean section rate was significantly lower than that in the control group (P<0.05),and there was no significant difference in the umbilical cord arterial blood pH,PO_(2),PCO_(2),ANP and ET-1 indexes and 1min Apgar score of the two groups of newborns (P>0.05).The fet al umbilical cord of the observation group arterial blood Lac decreased compared with the control group (P<0.05).Conclusion The combination of ropivacaine and fentanyl spinal epidural has ideal delivery analgesia.It can relieve the pain transmitters of the maternal body,has no inhibitory effect on the blood supply and cytokines of the fetus,and is more safety.