硬脊膜穿破硬膜外阻滞对无痛分娩罗哌卡因用量及应激反应和妊娠结局的影响

Effects of dural puncture epidural block on the dosage of Ropivacaine,stress response,and pregnancy outcome in painless delivery

目的探究硬脊膜穿破硬膜外阻滞对无痛分娩罗哌卡因用量及应激反应和妊娠结局的影响。方法选取2021年5月至12月徐州医科大学附属徐州妇幼保健院204名进行无痛分娩的孕妇为研究对象,采用随机数字表法分为硬脊膜穿破组(硬脊膜穿破硬膜外阻滞)和对照组(常规硬膜外阻滞),每组102名。比较两组镇痛前和镇痛30 min的血糖、血清皮质醇和去甲肾上腺素水平;比较两组镇痛前、镇痛30 min、镇痛60 min、娩出时的视觉模拟评分法(VAS)评分;比较两组镇痛起效时间,罗哌卡因消耗量,首次患者自控镇痛(PCA)时间;记录两组孕妇不良反应发生情况;比较两组新生儿出生后1、5 min Apgar评分及不良反应发生情况。结果镇痛30min,两组血糖、皮质醇、去甲肾上腺素水平高于镇痛前,差异有统计学意义(P<0.05);硬脊膜穿破组血糖、皮质醇、去甲肾上腺素水平低于对照组,差异有统计学意义(P<0.05)。两组组内不同时间点比较,差异有统计学意义(P<0.05);镇痛30 min、镇痛60 min、娩出时,硬脊膜穿破组VAS评分低于对照组,差异有统计学意义(P<0.05)。硬脊膜穿破组罗帕卡因用量低于对照组,镇痛起效时间短于对照组,首次PCA时间长于对照组,差异有统计学意义(P<0.05)。两组孕妇不良反应发生率比较,差异无统计学意义(P>0.05)。两组新生儿1、5 min Apgar评分比较,差异无统计学意义(P>0.05)。两组新生儿均未出现呼吸抑制与神经损伤等不良结局。结论硬脊膜穿破硬膜外阻滞起效快,降低孕妇应激反应,且可以减少罗哌卡因用量,对产妇和新生儿结局无不良影响。

Objective To investigate the effects of dural puncture epidural block on the dosage of Ropivacaine,stress response,and pregnancy outcome in painless delivery.Methods A total of 204 pregnant women who underwent painless delivery in Xuzhou Maternal and Child Health Hospital Affiliated to Xuzhou Medical University from May to December 2021 were selected as the research objects.They were divided into dural puncture group(dural puncture epidural block)and control group(routine epidural block),with 102 pregnant women in each group.The levels of blood glucose,serum cortisol,and norepinephrine in two groups were measured before analgesia and 30 min analgesia were compared;and the visual analogue scale(VAS)score in two groups before analgesia,30 min analgesia,60 min analgesia and delivery were compared;the onset time of analgesia,the consumption of Ropivacaine,the first patient controlled analgesia(PCA)time in two groups were compared;the occurrence of adverse reactions was recorded of pregnant women in two groups;the Apgar scores 1 and 5 min after birth and the occurrence of adverse reactions were compared between two groups.Results The levels of blood glucose,cortisol,and norepinephrine 30 min analgesia in two groups were higher than those before analgesia,and the differences were statistically significant(P<0.05);the levels of blood glucose,cortisol,and norepinephrine in dural puncture group were lower than those in control group,and the differences were statistically significant(P<0.05).There was statistical significance between two groups at different time points(P<0.05).The VAS scores of dural puncture group were lower than those of control group at 30 min analgesia,60 min analgesia and delivery,and the differences were statistically significant(P<0.05).The dosage of Ropivacaine in dural puncture group was lower than that in control group,the onset time of analgesia was shorter than that in control group,and the duration of first PCA was longer than that in control group,and the differences were statistically significant(P<0.05).There was no significant difference in the incidence of adverse reactions between two groups(P>0.05).There were no significant differences in Apgar scores 1 and 5 min between two groups(P>0.05).There were no adverse outcomes such as respiratory depression and nerve injury in two groups.Conclusion Dural puncture epidural block has quick effect,reduces stress response of pregnant women,and can reduce the dosage of Ropivacaine,which has no adverse effect on maternal and neonatal outcomes.