氢吗啡酮联合罗哌卡因用于分娩镇痛对患者血流动力学及母婴结局的影响

Effect of hydromorphone combined with ropivacaine for labor analgesia on hemodynamics,maternal and infant outcomes

目的探讨氢吗啡酮联合罗哌卡因用于分娩镇痛对患者血流动力学及母婴结局的影响。方法选择2018年4月至2020年4月四川大学华西医院眉山医院行分娩镇痛的单胎足月妊娠产妇150例, 按照随机数字表法分为对照组和观察组, 每组75例。对照组采用罗哌卡因分娩镇痛, 观察组则采用氢吗啡酮联合罗哌卡因分娩镇痛。比较两组产妇入室时(T_(1))、首剂量给予5 min(T_(2))、首剂量给予10 min(T_(3))、分娩后30 min(T_(4))、分娩后60 min(T_(5))时视觉模拟量表(VAS)评分、心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO_(2))变化, 记录两组产妇产程及母婴结局。结果两组T_(2)、T_(3)、T_(4)、T_(5)时VAS评分均降低, 并且观察组低于对照组[(5.12 ± 0.98)分比 (7.11 ± 1.10)分、(4.39 ± 0.61)分比(5.77 ± 0.75)分、(3.12 ± 0.38)分比(4.88 ± 0.91)分、 (2.12 ± 0.37)分比(3.98 ± 1.11)分], 差异有统计学意义(P<0.05)。两组不同时间点HR、MAP、SpO2比较差异均无统计学意义(P>0.05)。两组产妇第1、2、3产程比较差异均无统计学意义(P>0.05)。两组新生儿5 min Apgar评分及产妇不良反应发生率比较差异均无统计学意义(P>0.05)。结论氢吗啡酮联合罗哌卡因用于分娩镇痛效果理想, 对患者血流动力学影响小, 并且不增加母婴安全隐患。

Objective To investigate the effect of hydromorphone combined with ropivacaine on hemodynamics,maternal and infant outcomes in labor analgesia.Methods From April 2018 to April 2020,150 pregnant women with single full-term pregnancy undergoing labor analgesia in Meishan Hospital Affiliated of West China Hospital,Sichuan University were randomly divided into two groups,with 75 cases in each group.The control group was given ropivacaine for labor analgesia,while the observation group was given hydromorphone combined with ropivacaine for labor analgesia.The scores of visual analogue scale(VAS),heart rate(HR),mean arterial pressure(MAP)and blood oxygen saturation(SpO_(2))at the time of entering the room(T1),after the first dose for 5 min(T_(2)),10 min(T_(3)),after delivery for 30 min(T_(4))and 60 min(T_(5))were compared between the two groups.Results The scores of VAS at T_(2),T_(3),T_(4),T_(5) in two group were decreased,and the scores of VAS in the observation group were lower than that in the control group:(5.12±0.98)scores vs.(7.11±1.10)scores,(4.39±0.61)scores vs.(5.77±0.75)scores,(3.12±0.38)scores vs.(4.88±0.91)scores,(2.12±0.37)scores vs.(3.98±1.11)scores,the differences were statistically significant(P<0.05).The levels of HR,MAP,SpO_(2) in two groups at different time point had no significant differences(P>0.05).There were no significant difference between the first stage of labor,the second stage of labor and the third stage of labor(P>0.05).There was no significant difference in the 5 min Apgar score of newborns and the incidence of maternal adverse reactions between the two groups(P>0.05).Conclusions Hydromorphone combined with ropivacaine for labor analgesia effect is ideal,and has little impact on hemodynamics of patients,and will not increase the safety risk of mother and infant.