不同浓度罗哌卡因腰硬联合麻醉对妊娠期糖尿病产妇剖宫产术后VAS评分及MAP指标的影响

Effects of Combined Spinal Epidural Anesthesia with Different Concentrations of Ropivacaine on VAS Score and MAP Index in Puerperas with Gestational Diabetes Mellitus after Cesarean Section

目的分析妊娠期糖尿病(gestational diabetes mellitus,GDM)产妇采取不同浓度的罗哌卡因腰硬联合麻醉实施剖宫产术对其MAP指标和VAS评分的影响。方法选取2021年2月—2022年2月厦门大学附属妇女儿童医院(厦门市妇幼保健院)收治的采取罗哌卡因麻醉的剖宫产手术的GDM产妇90例为研究对象,随机分为A组、B组、C组,各30例,3组分别采用0.25%、0.375%、0.5%的罗哌卡因,对比3组麻醉相关指标、生命体征、术后VAS评分、微循环指标及不良反应情况。结果与A组和B组相比,C组感觉阻滞平面、Bromage评分更高,感觉阻滞时间更长,剖宫产术后2、4 h的静态VAS评分、动态VAS评分更低,术后24、48 h甲襞微循环指标更高,差异有统计学意义(P<0.05)。与B组和C组相比,A组麻醉15 min时,MAP更高、HR更低、不良反应更少,差异有统计学意义(P<0.05)。结论对于GDM产妇剖宫产来讲,浓度不同的罗哌卡因麻醉效果均良好,其中浓度0.5%有更好的镇痛效果,且对微循环影响更小;0.25%对血流动力学影响更小,不良反应更少.

Objective To analyze the effect of different concentrations of ropivacaine spinal epidural anesthesia on the MAP index and VAS score of parturients with gestational diabetes mellitus(GDM)undergoing cesarean section.Methods A total of 90 GDM parturients who received ropivacaine anesthesia for cesarean section in Women and Children's Hospital Affiliated to Xiamen University(Xiamen Maternal and Child Health Hospital)from February 2021 to February 2022 were selected as the research objects,and randomly divided into group A group B and group C,with 30 cases each.0.25%,0.375%and 0.5%Ropivacaine was used in three groups respectively.Anesthesia related indexes,vital signs,postoperative VAS scores,microcirculation indexes and adverse reactions of the three groups were compared.Results Compared with the group A and groups B,group C had higher sensory block plane and Bromage score,longer sensory block duration,lower static VAS score and dynamic VAS score at 2 and 4 h after cesarean section,and higher nail fold microcirculation index at 24 and 48 h after cesarean section,and the difference was statistically significant(P<0.05).Compared with the group B and groups C,MAP was higher,HR was lower and adverse reactions were less in group A after 15 min of anesthesia,and the difference was statistically significant(P<0.05).Conclusion For GDM women in caesarean section,different concentrations of ropivacaine anesthesia effect is good,and the concentration of 0.5%has better analgesic effect,and has less effect on microcirculation;0.25%has less effect on hemodynamics and fewer adverse reactions.