罗哌卡因联合舒芬太尼硬膜外麻醉对无痛分娩产妇母婴结局及应激反应的影响

Effects of Ropivacaine Combined with Sufentanil Epidural Anesthesia on Maternal and Infant Outcomes and Maternal Stress Response during Painless Delivery Parturients

目的:分析罗哌卡因联合舒芬太尼硬膜外麻醉对无痛分娩产妇母婴结局及应激反应的影响。方法:选择2020年1月-2021年10月于甘肃省人民医院分娩的150例产妇,根据产妇意愿将接受无痛分娩的80例产妇为无痛组,不接受无痛分娩的70例产妇为对照组。对照组进行常规分娩管理,无痛组在此基础上给予罗哌卡因联合舒芬太尼硬膜外麻醉无痛分娩。比较两组产程时间、剖宫产率;比较两组镇痛前(宫口开至约3 cm时)、镇痛后1 h及胎儿娩出时的视觉模拟评分法(VAS)评分;比较两组新生儿出生后1、5 min的Apgar评分;比较两组肠蠕动恢复时间及住院期间感染情况;比较两组镇痛前及分娩后血清应激反应指标[促肾上腺皮质激素(ACTH)、去甲肾上腺素(NE)及皮质醇(Cor)]水平。结果:无痛组剖宫产率低于对照组,差异有统计学意义(P<0.05)。无痛组第一、二产程时间均短于对照组,差异均有统计学意义(P<0.05)。两组第三产程时间比较,差异无统计学意义(P>0.05)。镇痛前,两组VAS评分比较,差异无统计学意义(P>0.05)。镇痛后1 h及胎儿娩出时,两组VAS评分均低于镇痛前,且无痛组均低于对照组,差异均有统计学意义(P<0.05)。出生后1、5 min,两组Apgar评分比较,差异均无统计学意义(P>0.05)。两组感染发生率比较,差异无统计学意义(P>0.05)。无痛组肠蠕动恢复时间短于对照组,差异有统计学意义(P<0.05)。分娩后,两组ACTH、NE、Cor均低于镇痛前,且无痛组均低于对照组,差异均有统计学意义(P<0.05)。结论:罗哌卡因联合舒芬太尼硬膜外麻醉无痛分娩有利于缩短产程、减轻分娩疼痛及剖宫产,减轻机体应激反应,促进产后恢复。

Objective:To analyze the effects of Ropivacaine combined with Sufentanil epidural anesthesia on maternal and infant outcomes and maternal stress response during painless delivery parturients.Method:A total of 150 parturients who delivered in Gansu Provincial People’s Hospital from January 2020 to October 2021 were selected,80 parturients who received painless delivery according to their wishes were selected as painless group,and 70 parturients who did not received painless delivery were selected as control group.The control group received routine delivery management,and the painless group received Ropivacaine combined with Sufentanil epidural anesthesia for painless delivery.The duration of labor and cesarean section rate were compared between two groups;visual analogue scale (VAS) scores were compared between two groups before analgesia (uterine mouth opening to about 3 cm),1 h after analgesia and at fetal delivery;Apgar scores were compared between two groups at 1 and 5 min after birth;intestinal peristalsis recovery time and infection during hospitalization were compared between two groups;the levels of serum stress response indexes[adrenocorticotropic hormone (ACTH),noradrenaline (NE) and cortisol (Cor)]before analgesia and after delivery were compared between two groups.Result:The cesarean section rate in the painless group was lower than that in the control group,and the difference was statistically significant (P0.05).Before analgesia,there was no significant difference in VAS scores between two groups (P>0.05).1 h after analgesia and at delivery,VAS scores in both groups were lower than those before analgesia,and those in painless group were lower than those in control group,the differences were statistically significant (P0.05).There was no significant difference in the incidence of infection between two groups (P<0.05).The recovery time of peristalsis in the painless group was shorter than that in the control group,and the difference was statistically significant (P<0.05).After delivery,ACTH,NE and Cor in both groups were lower than those before analgesia,and those in the painless group were lower than those in the control group,the differences were statistically significant (P<0.05).Conclusion:Ropivacaine combined with Sufentanil epidural anesthesia painless delivery is beneficial to shorten the course of labor,reduce labor pain and cesarean section,reduce the body’s stress response and promote postpartum recovery.