盐酸罗哌卡因联合舒芬太尼椎管内自控镇痛在分娩镇痛中的应用效果及对应激反应和妊娠结局的影响

Effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient controlled analgesia in delivery analgesia and its influence on stress reaction and pregnancy outcome

目的探讨盐酸罗哌卡因联合舒芬太尼椎管内自控镇痛(PCA)在分娩镇痛中的应用效果,及其对应激反应和妊娠结局的影响。方法回顾性分析2019年4月至2021年3月于成都市第七人民医院进行椎管内PCA分娩镇痛的97例产妇的一般资料,根据不同镇痛方法分为观察组(51例)和对照组(46例),观察组产妇给予盐酸罗哌卡因联合舒芬太尼椎管内PCA,对照组产妇给予盐酸罗哌卡因椎管内PCA。采用数字评分法(NRS)评价产妇分娩镇痛前、镇痛后15 min、镇痛后30 min、镇痛后45 min及宫口全开时的疼痛程度,统计产妇的镇痛起效时间、镇痛完善时间、盐酸罗哌卡因用量、舒芬太尼用量和镇痛药物总用量。采用酶联免疫吸附法(ELISA)检测血清皮质醇(COR)、促肾上腺皮质激素(ACTH)及去甲肾上腺素(NA)水平。统计产妇第一产程、活跃期、第二产程及第三产程时间,阴道出血量(产时及产后2 h内),催产素应用、正常分娩、产钳助产、会阴侧切和剖宫产比例,不良反应(瘙痒、发热、恶心呕吐、尿潴留、胎心过缓)发生情况和新生儿Apgar评分(出生后1 min和5 min)。结果两组产妇镇痛起效时间及完善时间,镇痛前和镇痛后15、30、45 min及宫口全开时NRS评分比较,差异无统计学意义(均P>0.05)。观察组盐酸罗哌卡因用量、镇痛药物总量明显少于对照组(均P<0.05)。镇痛后两组血清COR、ACTH和NA水平均较镇痛前降低,差异有统计学意义(均P<0.05);镇痛后两组血清COR、ACTH和NA水平比较,差异无统计学意义(均P>0.05)。观察组第二产程短于对照组,阴道出血量和剖宫产比例均低于对照组,正常分娩比例和胎儿出生后1 min Apgar评分均高于对照组,差异均有统计学意义(均P<0.05)。两组产妇镇痛效果、总不良反应发生率比较,差异无统计学意义(均P>0.05)。结论盐酸罗哌卡因联合舒芬太尼椎管内PCA可有效减轻分娩产痛,减少镇痛药物用量,利于改善母儿妊娠结局。

Objective To investigate the effect of ropivacaine hydrochloride combined with sufentanil for intraspinal patient-controlled analgesia(PCA)in labor analgesia,and its influence on stress response and pregnancy outcome.Methods The general data of 97 parturients who underwent intraspinal PCA delivery analgesia in Chengdu Seventh People′s Hospital from April 2019 to March 2021 were retrospectively analyzed.They were divided into the observation group(51 cases)and the control group(46 cases)according to different analgesia methods.The observation group parturients were given ropivacaine hydrochloride combined with sufentanil intraspinal PCA,and the control group parturients were given ropivacaine hydrochloride intraspinal PCA.The numerical scoring system(NRS)was used to evaluate the pain degree of the parturient before,15 minutes after,30 minutes after,45 minutes after analgesia and when the uterine orifice was fully opened.The onset time of analgesia,the time of perfection of analgesia,the amount of ropivacaine hydrochloride,sufentanil and the total amount of analgesic drugs were counted.The levels of serum cortisol(COR),adrenocorticotropic hormone(ACTH)and Norepinephrine(NA)were detected by enzyme-linked immunosorbent assay(ELISA).The time of the first stage of labor,the active stage,the second stage of labor,and the third stage of labor,the amount of vaginal bleeding(during labor and within 2 hours after delivery),the proportion of oxytocin application,normal labor,forceps delivery,lateral perineum resection,and caesarean section,the occurrence of adverse reactions(itching,fever,nausea and vomiting,urinary retention,and fetal bradycardia),and the Apgar score of newborns(1 min and 5 min after birth)were counted.Results There was no statistically significant difference in the onset time and improvement time of analgesia between the two groups of postpartum women,as well as the NRS scores before and after analgesia at 15,30,and 45 minutes,as well as when the cervix was fully opened(all P>0.05).The dosage of Ropivacaine hydrochloride and the total amount of analgesics in the observation group were significantly less than those in the control group(all P<0.05).After analgesia,the serum levels of COR,ACTH,and NA in both groups decreased significantly compared to before analgesia(all P<0.05);After analgesia,there was no statistically significant difference in serum COR,ACTH,and NA levels between the two groups(all P>0.05).The second stage of labor in the observation group was shorter than that in the control group,the vaginal bleeding volume and the proportion of caesarean section were lower than those in the control group,the proportion of normal delivery and the Apgar score 1 min after birth of the fetus were higher than those in the control group,and the difference was statistically significant(all P<0.05).There was no statistically significant difference in the analgesic effect and total incidence of adverse reactions between the two groups of postpartum women(all P>0.05).Conclusions Ropivacaine hydrochloride combined with sufentanil intraspinal PCA can effectively alleviate labor pain,reduce the amount of analgesics,and improve maternal and fetal pregnancy outcomes.