硬膜外规律间断给药和持续给药麻醉对初产妇血清指标、疼痛及分娩结局的影响

Effects of epidural regular intermittent administration and continuous administration anaesthesia on serum indexes,pain and delivery outcomes in primiparas

目的探讨硬膜外规律间断给药和持续给药麻醉对初产妇血清指标、疼痛及分娩结局的影响。方法按照麻醉给药方式不同将160例实施硬膜外麻醉的初产妇分为对照组和观察组,各80例。对照组实施硬膜外持续给药麻醉,观察组实施硬膜外规律间断给药麻醉。比较两组的血清指标、疼痛评分及分娩情况。结果分娩时,两组的白细胞介素-6(IL-6)、组织型纤溶酶原激活物(tPA)、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)水平均高于分娩前、分娩后2 h,但观察组低于对照组(P<0.05)。两组的催乳素(PRL)水平在分娩过程中呈现升高趋势(P<0.05);分娩时,观察组的PRL水平高于对照组(P<0.05)。镇痛后1、2、3 h及分娩时、分娩后1 h,两组的视觉模拟评分法(VAS)评分均低于镇痛前(P<0.05);镇痛后3 h,观察组的VAS评分低于对照组(P<0.05)。观察组的舒芬太尼、罗哌卡因总用量均少于对照组(P<0.05)。结论与硬膜外持续给药麻醉比较,硬膜外规律间断给药麻醉可有效改善初产妇的血清指标水平,减少麻醉药物用量,镇痛效果更佳。

Objective To investigate the effects of epidural regular intermittent administration and continuous administration anaesthesia on serum indexes,pain and delivery outcome of primiparas.Methods A total of 160 primiparas with epidural anesthesia were divided into control group and observation group according to different anaesthesia administration methods,with 80 cases in each group.The control group was given epidural continuous administration anaesthesia,and the observation group was given epidural regular intermittent administration anaesthesia.The serum indexes,pain score and delivery were compared between the two groups.Results At delivery,the levels of interleukin-6(IL-6),tissue plasminogen activator(tPA),norepinephrine(NE)and adrenocorticotropic hormone(ACTH)in the two groups were higher than those before delivery and at 2 h after delivery,but those in the observation group were lower than the control group(P<0.05).The level of prolactin(PRL)in both groups showed an increasing trend during delivery(P<0.05);at delivery,the PRL level in the observation group was higher than that in the control group(P<0.05).The scores of Visual Analogue Scale(VAS)in the two groups at 1,2 and 3 h after analgesia,at delivery and 1 h after delivery were lower than those before analgesia(P<0.05);at 3 h after analgesia,the score of VAS in the observation group was lower than that in the control group(P<0.05).The total dosage of sufentanil and ropivacaine in the observation group were less than those in the control group(P<0.05).Conclusion Compared with epidural continuous administration anaesthesia,epidural regular intermittent administration anaesthesia can effectively improve the serum indexes levels of primiparas,reduce the dosage of anesthetic drugs,and has better analgesic effect.