硬膜外分娩镇痛对产妇胃窦排空的影响

Effect of epidural analgesia during labor on gastric emptying of parturient

目的观察硬膜外分娩镇痛对产妇胃窦排空的影响。方法选择孕足月初产妇87例,年龄20~40岁,BMI 20~40 kg/m^(2),ASAⅡ或Ⅲ级。根据自愿是否需要分娩镇痛分为两组:镇痛组和对照组,其中镇痛组43例,对照组44例。镇痛组在L_(2-3)行硬膜外穿刺置管术,置管成功后连接硬膜外自控镇痛泵,镇痛药物配方为0.08%罗哌卡因+舒芬太尼0.4μg/ml。对照组不使用分娩镇痛。超声检查胃窦排空后给予碳水化合物饮料300 ml,分娩期间产妇不再进食其他食物饮料。记录胃窦排空即刻、饮用碳水化合物后5、30、60、120 min和宫口开全时的胃窦横截面积(CSA)、单位体重胃容量(GV_(W))和VAS疼痛评分。记录第一和第二产程时间、胃窦再次排空所需时间。记录分娩期间恶心和中转剖宫产情况。记录新生儿1 min和5 min的Apgar评分。记录产后住院时间。结果与对照组比较,镇痛组饮用碳水化合物后30、60、120 min和宫口开全时CSA和GV_(W)明显减小(P<0.05),胃窦排空即刻、饮用碳水化合物后5、30、60、120 min和宫口开全时VAS疼痛评分明显降低(P<0.05)胃窦再次排空时间明显缩短(P<0.05)。两组第一和第二产程时间、恶心发生率、新生儿出生后1 min和5 min的Apgar评分、产后住院时间差异无统计学意义。结论硬膜外分娩镇痛会加快产妇胃窦排空,产程中饮用300 ml的碳水化合物饮品对母婴结局无不良影响。

Objective To observe the effect of epidural analgesia on the speed of gastric emptying of parturients during labor.Methods Eighty-seven primiparas,aged 20-40 years,BMI 20-40 kg/m^(2),ASA physical statusⅡorⅢ,to be delivered were selected.They were divided into two groups according to the voluntary need for labor analgesia,43 cases in analgesia group and 44 cases in control group.In the analgesia group,epidural puncture and catheterization were performed in L_(2-3).After successful catheterization,the patient-controlled epidural analgesia pump was used.The analgesic drug formula was 0.08%ropivacaine+0.4μg/ml sufentanil.The control group was not given epidural analgesia.Then each subjects drank liquid 300 ml after empty stomach with ultrasound examination.Subjects were not allowed to intake anything during labor.At immediate emptying of gastric antrum,5,30,60,and 120 minutes after drinking carbohydrates and complete cervical dilatation,gastric antrum cross-sectional area(CSA),gastric volume per unit weight(GV_(W))and VAS score were recorded.The time of the first and second stages of labor and the time required for the re-empty of the gastric antrum were recorded.Nausea,vomiting and conversion to cesarean section during delivery were recorded.Apgar scores at 1 minute and 5 minutes were recorded.The postpartum hospital stay was recorded.Results Compared with the control group,CSA and GV_(W) in the epidural analgesia group decreased significantly 30,60,and 120 minutes after drinking carbohydrates(P<0.05).The VAS score of the analgesia group was significantly lower than that of the control group immediately after gastric antrum emptying,5,30,60,and 120 minutes after drinking carbohydrates and at the time of full uterine opening(P<0.05).The time of gastric emptying in the analgesic group was significantly shorter than that in the control group(P<0.05).There was no significant difference between the two groups in the time of the first and second stage of labor,the incidence of nausea,the length of postpartum hospital stay,and the Apgar score at 1 minute and 5 minutes after birth.Conclusion Epidural labor analgesia can accelerate the emptying speed of parturient gastric antrum.Drinking carbohydrate drinks 300 ml during labor has no adverse effect on maternal and infant outcomes.