硬膜外间隔脉冲给药0.4μg/mL舒芬太尼联合不同浓度罗哌卡因在无痛分娩中的临床研究

Clinical Study of Epidural Septal Pulse Administration of 0.4 μg/mL Sufentanil Combined with Different Concentrations of Ropivacaine in Painless Delivery

目的 探讨不同浓度罗哌卡因联合0.4μg/mL舒芬太尼硬膜外间隔脉冲给药在无痛分娩中的应用效果。方法 选取2020年3月—2021年9月于该院产科进行无痛分娩的146例产妇为研究对象,全部产妇均以罗哌卡因联合0.4μg/mL舒芬太尼进行硬膜外间隔脉冲给药。随机分为3组。A组49例,0.06%罗哌卡因+0.4μg/mL舒芬太尼;B组49例,0.08%罗哌卡因+0.4μg/mL舒芬太尼;C组48例,0.10%罗哌卡因+0.4μg/mL舒芬太尼。硬膜外给药后不同时间点,以视觉模拟评分法(VAS)评估3组产妇疼痛情况,以Bromage评分评估3组运动阻滞情况,统计3组镇痛药物追加情况、爆发痛以及产程中不良事件发生率。结果 宫口全开、胎儿娩出时及胎儿娩出后2 h,B组、C组VAS评分均低于A组,差异有统计学意义(P<0.05),B组和C组间比较差异无统计学意义(P>0.05)。胎儿娩出后2 hA、B两组Bromage评分比C组更优,差异有统计学意义(P<0.05)。A组镇痛药物追加率(22.45%)高于B组(6.12%)和C组(0.00%),差异有统计学意义(P<0.05),A组爆发痛发生率高于C组,差异有统计学意义(P<0.05),3组低血压、心动过缓等并发症发生率差异无统计学意义(P>0.05)。结论 硬膜外间隔脉冲给药,参数设置:持续剂量8 mL/h,脉冲量8 mL,自控剂量8 mL,锁定时间30 min,无痛分娩采用罗哌卡因联合0.4μg/mL舒芬太尼的给药方案,0.08%罗哌卡因镇痛效果佳,对产妇运动功能影响小,产程不良事件发生率低。

Objective To investigate the effect of epidural septal pulse administration of different concentrations of ropivacaine combined with 0.4 μg/mL sufentanil in painless delivery. Methods 146 parturients who delivered painlessly in the obstetrics of the hospital from March 2020 to September 2021 were studied. All parturients were given epidural septal pulse administration with ropivacaine combined with 0.4 μg/mL sufentanil. Randomly divided into three groups. 49 cases in group A, 0.06% ropivacaine + 0.4 μg/mL sufentanil;49 cases in group B, 0.08% ropivacaine + 0.4 μg/mL sufentanil;48 cases in group C, 0.10%ropivacaine + 0.4 μg/mL sufentanil. At different time points after epidural administration, visual analogue scale(VAS) was used to evaluate the maternal pain of the three groups, and Bromage score was used to evaluate the motor block of the three groups. The addition of analgesic drugs, explosive pain and the incidence of adverse events during labor were counted. Results The VAS scores of group B and group C were significantly lower than those of group A,the difference was statistically signifi cant(P<0.05), but there was no significant difference between group B and group C(P>0.05). The Bromage score of group A and group B was better than that of group C 2 h after delivery, and the difference was statistically significant(P<0.05). The addition rate of analgesic drugs in group A(22.45%)was significantly higher than that in group B(6.12%) and group C(0.00%),the difference was statistically significant(P<0.05). The incidence of explosive pain in group A was significantly higher than that in group C,the difference was statistically significant(P<0.05). There was no significant difference in the incidence of complications such as hypotension and bradycardia among the three groups(P>0.05). Conclusion Epidural septal pulse administration, parameter setting: continuous dose 8 mL/h, pulse volume 8 mL, self-control dose 8 mL, locking time 30 min, painless delivery with ropivacaine combined with 0.4 μg/mL sufentanil administration regimen, 0.08% ropivacaine has good analgesic effect, has little impact on maternal motor function, and the incidence of adverse events during labor is low.