盐酸罗哌卡因复合舒芬太尼在硬膜外分娩镇痛中对初产妇第一产程及分娩质量的临床观察

Clinical observation of ropivacaine hydrochloride combined with sufentanil in epidural labor analgesia for primiparas in the first stage of labor and delivery quality

目的探讨盐酸罗哌卡因复合舒芬太尼在硬膜外分娩镇痛中对初产妇第一产程、分娩过程中的安全性及对分娩质量的影响。方法选取82例拟行阴道分娩的初产妇,经知情同意和自主选择将其分为自然分娩的观察组(29例)与行椎管内镇痛的镇痛组(53例)。两组产妇均在严密监护下经阴道分娩试产,观察并比较两组临床指标。结果镇痛组干预时间点(产妇宫口大小)最小1 cm,最大4.5 cm,平均(3.12±0.69)cm;硬膜外麻醉温觉消失平面均为T(8.00±1.65)。镇痛组初产妇4例改行剖宫产,1例因进展太慢,9 h余宫口开6 cm;2例为社会因素;1例为胎儿宫内窘迫。观察组初产妇1例改行剖宫产,原因为胎头持续不下降。两组新生儿pH、氧分压(PO_(2))、二氧化碳分压(PCO_(2))指标比较,差异无统计学意义(P>0.05)。观察组不良反应发生率为14.29%,镇痛组为16.33%,比较差异无统计学意义(P>0.05)。结论盐酸罗哌卡因复合舒芬太尼用于椎管内经阴道分娩自控镇痛并不延长初产妇第一产程,也不影响分娩的安全性,并能够提供产妇满意的分娩体验,提高分娩质量。

Objective To investigate the safety of ropivacaine hydrochloride combined with sufentanil for epidural labor analgesia in primiparas during the first stage of labor and labor and the effect on delivery quality.Methods 82 primiparas who planned to undergo vaginal delivery were selected and divided into observation group(n=29)and analgesia group(n=53)by informed consent and independent choice.Two groups of parturient women were under close supervision of vaginal delivery trial labor,observe and compare the clinical indicators of the two groups.Results In the analgesia group,the smallest and the largest time points(uterine mouth size of puerpera)were 1cm and 4.5cm,with an average of(3.12±0.69)cm.The plane of temperature loss in epidural anesthesia was T(8.00±1.65).In the analgesia group,4 cases of primiparas underwent cesarean section,1 case was more than 6 cm in 9 hours due to slow progress;2 cases were due to social factors.Intrauterine fetal distress was found in 1 case.One primipara in the observation group underwent cesarean section because the fetal head did not decrease.There was no significant difference in pH,partial pressure of oxygen(PO_(2))and partial pressure of carbon dioxide(PCO_(2))between the two groups(P>0.05).The incidence of adverse reactions was 14.29%in the observation group and 16.33%in the analgesia group,and the difference was not statistically significant(P>0.05).Conclusion Ropivacaine hydrochloride combined with sufentanil for patient-controlled analgesia for intraspinal vaginal delivery does not prolong the first stage of labor,nor does it affect the safety of delivery,and can provide women with a satisfactory delivery experience and improve delivery quality.