罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉在分娩镇痛中的应用价值

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

目的研究罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉在分娩镇痛中的应用价值。方法选取2020年9月-2021年9月于安福县中医院行无痛分娩的60例产妇作为研究对象,按照随机数字表法分为对照组与观察组,各30例。对照组采用罗哌卡因复合瑞芬太尼常规硬膜外阻滞麻醉,观察组采用罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉。比较两组疼痛视觉模拟评分(VAS)、镇痛起效时间、产程时间、血清脂联素、皮质醇水平、转剖宫产率、母乳喂养率及镇痛副作用。结果观察组第一产程、第二产程中VAS评分低于对照组(P<0.05),且镇痛起效时间短于对照组(P<0.05);观察组产程时间短于对照组(P<0.05);对照组脂联素水平下降、皮质醇水平升高,而观察组脂联素水平升高、皮质醇水平下降,组内及组间比较,差异均有统计学意义(P<0.05);观察组转剖宫产率低于对照组,母乳喂养率高于对照组(P<0.05);两组镇痛副作用发生率比较,差异无统计学意义(P>0.05)。结论罗哌卡因复合瑞芬太尼腰麻-硬膜外麻醉用于分娩镇痛效果肯定,可有效缩短镇痛起效时间及产程时间,调节应激相关指标,降低剖宫产率,同时提高产后母乳喂养率,且镇痛副作用少。

Objective To study the application value of ropivacaine combined with remifentanil spinal-epidural anesthesia in labor analgesia.Methods From September 2020 to September 2021,60 parturients who underwent painless delivery in Anfu County Hospital of Traditional Chinese Medicine were selected as the research objects.They were divided into control group and observation group according to the random number table method,30 cases in each group.The control group was treated with ropivacaine combined with remifentanil for routine epidural block anesthesia,and the observation group was treated with ropivacaine combined with remifentanil for spinal-epidural anesthesia.The visual analogue scale(VAS),analgesic onset time,labor time,serum adiponectin,cortisol levels,cesarean section rate,breastfeeding rate and analgesic side effects were compared between the two groups.Results The VAS scores in the first and second stages of labor in the observation group were lower than those in the control group(P<0.05),and the onset time of analgesia was shorter than that in the control group(P<0.05).The labor time of the observation group was shorter than that of the control group(P<0.05).The level of adiponectin decreased and the level of cortisol increased in the control group,while the level of adiponectin increased and the level of cortisol decreased in the observation group,and the differences were statistically significant(P<0.05).The cesarean section rate in the observation group was lower than that in the control group,and the breastfeeding rate was higher than that in the control group(P<0.05).There was no significant difference in the incidence of analgesic side effects between the two groups(P>0.05).Conclusion Ropivacaine combined with remifentanil and epidural anesthesia for labor analgesia is effective,which can effectively shorten the onset time of analgesia and labor time,adjust the related indicators of stress,reduce the rate of cesarean section,and improve the rate of postpartum breastfeeding,with fewer analgesic side effects.