罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉在分娩镇痛中的价值

The Value of Ropivacaine with Remifentanil Combined Spinal-epidural Anesthesia in Labor Analgesia

目的 探讨罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉(CSEA)在分娩镇痛中的应用价值。方法 选取2020年1月-2021年6月东乡区人民医院行CSEA分娩镇痛的产妇84例为研究对象,随机分为镇痛A组和镇痛B组,每组42例。镇痛A组应用罗哌卡因麻醉,镇痛B组应用罗哌卡因联合瑞芬太尼麻醉。比较不同时间节点两组产妇心率、平均动脉压、疼痛评分,两组麻醉起效时间、麻醉起效后1 h Ramsay评分、产程及剖宫产率。结果 麻醉镇痛后1 h,两组心率均低于麻醉镇痛前,镇痛B组高于镇痛A组,差异有统计学意义(P<0.05);分娩后1 h,镇痛B组心率、平均动脉压与麻醉镇痛前比较,差异无统计学意义(P>0.05);分娩后1 h,镇痛A组心率高于镇痛前和镇痛B组,平均动脉压低于镇痛前和镇痛B组,差异有统计学意义(P<0.05);麻醉镇痛后1 h、分娩后1 h,两组VAS评分低于麻醉镇痛前,镇痛B组低于镇痛A组,差异有统计学意义(P<0.05);镇痛B组麻醉起效时间、产程短于镇痛A组,麻醉起效后1 h Ramsay评分高于镇痛A组,剖宫产率低于镇痛A组,差异有统计学意义(P<0.05)。结论 罗哌卡因复合瑞芬太尼CSEA能够达到较好的分娩镇痛效果,能够促进产妇血流动力学稳定,缩短产程,减少剖宫产率。

Objective To explore the application value of ropivacaine with remifentanil combined spinal-epidural anesthesia(CSEA) for labor analgesia.Methods From January 2020 to June 2021,84 parturients undergoing CSEA labor analgesia in Dongxiang District People’s Hospital were randomly divided into analgesia group A and analgesia group B,with 42 cases in each group.Analgesia group A received ropivacaine anesthesia,analgesia group B received ropivacaine combined with remifentanil anesthesia.The heart rate,mean arterial pressure and pain score of the two groups at different time points were compared.The onset time of anesthesia,Ramsay score 1 h after the onset of anesthesia,labor process and cesarean section rate were compared between the two groups.Results At 1 h after anesthesia,the heart rate of the two groups was lower than that before anesthesia,and the heart rate of group B was higher than that of group A,the difference was statistically significant( P0.05).At 1 h after delivery,the heart rate of analgesia group A was higher than that before analgesia and analgesia group B,and the mean arterial pressure was lower than that before analgesia and analgesia group B,the difference was statistically significant(P<0.05).At 1 h after analgesia and 1 h after delivery,the VAS scores of the two groups were lower than those before anesthesia analgesia,and the analgesia group B was lower than the analgesia group A,the differences were statistically significant(P<0.05).The onset time and labor stage of anesthesia inanalgesia group B were shorter than those in analgesia group A,the Ramsay score at 1 h after the onset of anesthesia was higher than that in analgesia group A,and the cesarean section rate was lower than that in analgesia group A,the differences were statistically significant(P <0.05).Conclusion Ropivacaine with remifentanil CSEA can achieve good labor analgesia effect,promote maternal hemodynamic stability,shorten the labor process,reduce the rate of cesarean section.