不同硬膜外自控镇痛方法对无痛分娩产妇妊娠结局的影响

Effects of different patient-controlled epidural analgesia methods on the pregnancy outcomes in parturients undergoing painless delivery

目的研究不同硬膜外自控镇痛方法对无痛分娩产妇妊娠结局的影响。方法以2019年1月至2022年8月于滨州市中心医院分娩的110例产妇为研究对象开展前瞻性随机对照试验,根据患者就诊序号采用电脑随机数字表法分为对照组和观察组,各55例。观察组年龄22~35(26.79±3.18)岁,孕周37~40(39.15±0.42)周,美国麻醉医师协会(ASA)分级Ⅰ级30例、Ⅱ级25例;对照组年龄23~34(27.01±3.14)岁,孕周37~41(39.24±0.39)周,ASA分级Ⅰ级28例、Ⅱ级27例。对照组采用盐酸罗哌卡因硬膜外自控镇痛,观察组采用枸橼酸舒芬太尼联合盐酸罗哌卡因硬膜外自控镇痛。比较两组不同时间点视觉模拟评分量表(VAS)评分、产程、妊娠结局、Apgar评分、产后出血量、泌乳功能[泌乳开始时间、血清泌乳素(PRL)水平(分娩前1 d、分娩后24 h)]、分娩前后血清纤溶功能指标[纤溶酶原活性抑制物-1(PAI-1)、组织型纤溶酶原激活物(t-PA)、D-二聚体(D-D)]。采用t检验、χ2检验。结果观察组分娩镇痛后10 min、30 min VAS评分[(4.58±0.36)分、(3.03±0.41)分]均低于对照组[(5.71±0.44)分、(3.96±0.38)分],差异均有统计学意义(均P<0.05)。观察组第二产程、第三产程时间[(74.26±11.85)min、(6.74±2.63)min]均低于对照组[(90.43±12.57)min、(9.11±3.02)min],差异均有统计学意义(均P<0.05)。观察组Apgar评分[(9.38±0.17)分]高于对照组[(8.85±0.22)分],产后出血量[(218.65±24.39)ml]低于对照组[(291.07±38.61)ml],差异均有统计学意义(均P<0.05)。观察组泌乳开始时间[(27.37±5.18)h]低于对照组[(36.02±6.34)h],分娩后血清PRL水平[(328.09±41.18)μg/L]高于对照组[(257.63±36.54)μg/L],差异均有统计学意义(均P<0.05)。分娩后观察组血清PAI-1、t-PA、D-D水平[(25.92±3.26)μg/L、(13.77±2.06)μg/L、(151.09±16.77)μg/L]均低于对照组[(39.38±3.74)μg/L、(20.82±3.14)μg/L、(179.62±18.41)μg/L],差异均有统计学意义(均P<0.05)。结论采用枸橼酸舒芬太尼联合盐酸罗哌卡因硬膜外自控镇痛进行无痛分娩可显著降低产妇疼痛程度,缩短产程,降低产后出血量,抑制纤溶亢进,提高泌乳功能,降低不良妊娠结局发生风险。

Objective To study the effects of different patient-controlled epidural analgesia methods on the pregnancy outcomes in parturients undergoing painless delivery.Methods It was a prospective randomized controlled trial.A total of 110 parturients who delivered in Binzhou Central Hospital from January 2019 to August 2022 were selected as the research objects,and were randomly divided into a control group and an observation group with 55 cases in each group by the random number table method.The observation group was 22 to 35(26.79±3.18)years old,with a gestational age of 37 to 40(39.15±0.42)weeks,with an American Society of Anesthesiologists(ASA)grade of gradeⅠin 30 cases and gradeⅡin 25 cases.The control group was 23 to 34(27.01±3.14)years old,with a gestational age of 37 to 41(39.24±0.39)weeks,with an ASA grade of gradeⅠin 28 cases and gradeⅡin 27 cases.The control group used ropivacaine hydrochloride patient-controlled epidural analgesia,and the observation group used sufentanil citrate combined with ropivacaine hydrochloride patient-controlled epidural analgesia.The Visual Analogue Scale(VAS)scores at different time points,labor,pregnancy outcome,Apgar score,amount of postpartum blood loss,lactation function[lactation start time and serum prolactin(PRL)levels 1 d before delivery and 24 h after delivery],serum fibrinolytic function indicators[plasminogen activity inhibitor-1(PAI-1),tissue type plasminogen activator(t-PA),and D-dimer(D-D)]before and after delivery were compared between the two groups.t test andχ2 test were used.Results The VAS scores 10 min and 30 min after labor analgesia in the observation group[(4.58±0.36)points and(3.03±0.41)points]were lower than those in the control group[(5.71±0.44)points and(3.96±0.38)points],with statistically significant differences(both P<0.05).The second and third stages of labor in the observation group[(74.26±11.85)min and(6.74±2.63)min]were lower than those in the control group[(90.43±12.57)min and(9.11±3.02)min],with statistically significant differences(both P<0.05).The Apgar score[(9.38±0.17)points]in the observation group was higher than that in the control group[(8.85±0.22)points],and the amount of postpartum blood loss[(218.65±24.39)ml]was lower than that in the control group[(291.07±38.61)ml],with statistically significant differences(both P<0.05).The start time of lactation in the observation group[(27.37±5.18)h]was shorter than that in the control group[(36.02±6.34)h],and the serum PRL level after delivery[(328.09±41.18)μg/L]was higher than that in the control group[(257.63±36.54)μg/L],with statistically significant differences(both P<0.05).After delivery,the levels of PAI-1,t-PA,and D-D in the observation group[(25.92±3.26)μg/L,(13.77±2.06)μg/L,and(151.09±16.77)μg/L]were lower than those in the control group[(39.38±3.74)μg/L,(20.82±3.14)μg/L,and(179.62±18.41)μg/L],with statistically significant differences(all P<0.05).Conclusion The patient-controlled epidural analgesia of sufentanil citrate combined with ropivacaine hydrochloride for painless delivery can significantly reduce the degree of pain in parturients,shorten the labor process,reduce the amount of postpartum hemorrhage,inhibit the fibrinolysis,improve the lactation function,and reduce the risk of adverse pregnancy outcomes.