不同剂量氢吗啡酮联合罗哌卡因用于硬膜外分娩镇痛效果及对血氧影响

Effect of different doses of hydromorone combined with ropivacaine for epidural labor analgesia of pregnant women and its influence on their blood oxygen indexes values

目的:探讨不同剂量氢吗啡酮联合罗哌卡因用于硬膜外分娩镇痛效果及对血氧饱和度(SPO2)、平均动脉压(MAP)、心率(HR)影响。方法:选取2020年9月-2021年4月本院收治的单胎足月初产妇120例,随机化原则分4组各30例,硬膜外麻醉后行脉冲式自控硬膜外泵镇痛维持,镇痛泵组成分别为对照组0.1%盐酸罗哌卡因注射液,低、中、高浓度组分别为氢吗啡酮(5、10、15)μg/ml+0.1%盐酸罗哌卡因注射液,生理盐水稀释至250ml,脉冲剂量8ml/h,自控镇痛量6ml/次,时间锁定30min。对比4组镇痛后10min、30min、2h、4h视觉模拟疼痛评分(VAS)、麻醉起效时间、产程时间、镇痛前、镇痛后30min及胎儿娩出时MAP、SPO2、HR值,镇痛后30min、胎儿娩出时Bromage评分及新生儿出生后Apgar评分,评价用药安全性。结果:中、高剂量组分娩镇痛后10min、30min、2h、4hVAS评分以及麻醉起效时间等无差异但均低于低剂量组和对照组(P<0.05);第一、第二、第三产程持续时间,镇痛前、镇痛后30min及胎儿娩出时MAP、SPO2、HR值,镇痛后30min、胎儿娩出时Bromage评分,新生儿出生后1min和5min Apgar评分,产妇恶心呕吐发生率、呼吸抑制率和镇静评分4组均无差异(均P>0.05)。结论:氢吗啡酮联合罗哌卡因用于硬膜外分娩具有较好的镇痛效果,综合比较氢吗啡酮推荐浓度为10μg/ml。

Objective:To investigate the effects of different doses of hydromorone combined with ropivacaine for epidural labor analgesia of women,and to study its influence on the values of their SPO2,mean arterial pressure(MAP),and heart rate(HR).Methods:120full-term primiparas with single-fetus were selected and divided into four groups(30cases in each group)by the principle of block randomization from September 2020to April 2021.After epidural anesthesia,pulse automatic epidural pump was used for analgesia maintenance of the women in the four groups.And the parameters of automatic epidural pump included the analgesia drugs were diluted by 250ml normal saline,the pulse dose was 8ml/h,the automatic analgesia dose was 6ml/time,and the time was locked for 30min.The women in group A were given 0.1%ropivacaine for analgesia maintenance.Except to the 0.1%ropivacaine given,the women in group B were given 5μg·ml-1hydromorphone additionally,the women in group C were given 10μg·ml-1hydromorphone additionally,and the women in group D were given 15μg·ml-1hydromorphone additionally.The visual analog pain score(VAS),the onset time of anesthesia,the labor time,the values of MAP,SPO2,and HR at pre-analgesia,post-analgesia 30min,and fetal delivery,Bromage score value at 30min after analgesia and delivery of the women,and the newborn Apgar score after birth were compared among the four groups.The safety of the drug used was also evaluated.Results:There was no significant difference in VAS scores at 10min,30min,2h,and 4hafter labor analgesia,and the onset time of anesthesia of the women between group C and group D,but which of the women in group C and group D were all significantly lower than those of the women in group B and group A(P<0.05).There were no significant differences in the durations of the first stages of labor,the second stages of labor,and the third stages of labor,and the values of MAP,SPO2,and HR of the women before analgesia,at 30min after analgesia,and at delivery,Bromage score of the women at 30min after analgesia and during delivery,and Apgar score of the newborn at 1min and 5min after birth,and the incidences of maternal nausea,vomiting,respiratory depression,and sedation score among the four groups(all P>0.05).Conclusion:Hydromorphone(10μg/ml as recommended concentration)combined with ropivacaine for epidural labor analgesia has good effect.