浓度递增法程控硬膜外间歇脉冲注入罗哌卡因在妊娠期糖尿病产妇围术期的应用效果

Perioperative effect of intermittent epidural pulse injection of ropivacaine in concentration progressively increasing method in pregnant women with GDM

目的探讨浓度递增法程控硬膜外间歇脉冲注入罗哌卡因对妊娠期糖尿病产妇围术期血糖的影响。方法选择2019年10月至2022年10月阆中市人民医院收治的121例妊娠期糖尿病产妇为研究对象,根据麻醉模式的不同将患者分为观察组(64例)和对照组(57例),其中观察组为采用浓度递增法程控硬膜外间歇脉冲注入模式进行麻醉的患者,对照组为采用持续背景输入模式进行麻醉的患者。多因素Logistic回归分析影响产妇围术期血糖的危险因素;构建列线图模型,通过受试者工作特征(ROC)曲线和校准曲线评价模型区分度和准确度,采用Bootstrap重采样对列线图模型进行内部验证。结果观察组镇痛后1h、镇痛后2h、镇痛后4h、宫口全开时及分娩时的血糖浓度均低于对照组,差异有统计学意义(t值介于12.628~26.782之间,P<0.05);镇痛后2h、镇痛后4h、宫口全开时及分娩时,观察组视觉模拟疼痛(VAS)评分均低于对照组(t值介于8.196~18.883之间,P<0.05);观察组第一产程时间、总产程时间、出血量、自控镇痛追加次数、用药量、产钳使用率均低于对照组,镇痛满意度高于对照组,差异有统计学意义(t/χ^(2)值介于2.301~11.537之间,P<0.05);多因素Logistic回归分析结果显示,镇痛后较高的VAS评分、产程时间、自控镇痛追加次数、用药量、使用产钳率均为影响产妇围术期血糖的独立危险因素(OR值介于2.124~4.400之间,P<0.05);ROC曲线和校准曲线结果均显示列线图模型具有较好的区分度和校准度。结论浓度递增法程控硬膜外间歇脉冲注入罗哌卡因对控制妊娠期糖尿病产妇围术期血糖稳定具有积极作用,并且镇痛效果明显,能缩短产程,减少用药量,值得临床广泛推广应用。

Objective To explore effect of programmed epidural intermittent pulse injection of ropivacaine in concentration progressively increasing method on perioperative blood glucose of pregnant women with GDM.Methods 121 pregnant women with GDM who admitted to Langzhong Municipal People s Hospital from October 2019 to October 2022 were selected as study subjects.According to different anesthesia modes,the pregnant women were divided into observation group(64 cases)and control group(57 cases).The pregnant women in the observation group were anesthetized by using programmed epidural intermittent pulse injection mode in concentration progressively increasing method,while those in the control group were anesthetized by using continuous background input mode.Multivariate Logistic regression analysis was used to analyze risk factors that affect perioperative blood glucose level.A nomogram model was constructed,and discrimination and accuracy of the model were evaluated through ROC curves and calibration curves.Bootstrap resampling was used to conduct internal validation for the nomogram model.Results The blood glucose concentrations of the pregnant women in the observation group were lower than those in the control group at 1 hour,2 hours,4 hours,full opening of the cervix and delivery,there were statistically significant differences(t values ranged from 12.628 to 26.782,all P<0.05).The scores in visual analog scale(VAS)of the pregnant women in the observation group were lower than those in the control group at 2 hours after analgesia,4 hours after analgesia,full opening of the cervix and delivery(t values ranged from 8.196 to 18.883,all P<0.05).The time of the first stage of labor,time of total stage of labor,bleeding volume,additional frequency of patient-controlled analgesia,medication dosage and forceps usage rate of the pregnant women in the observation group were shorter and less than those in the control group,however,the satisfaction with analgesia was higher than that in the control group,there were statistically significant differences(t/χ^(2) values ranged from 2.301 to 11.537,all P<0.05).The multivariate Logistic regression analysis showed that VAS scores,duration of labor,additional frequency of patient-controlled analgesia,medication dosage and forceps usage rate after analgesia were all independent risk factors that affect maternal perioperative blood glucose(OR values ranged from 2.124 to 4.400,all P<0.05).The ROC curve and the calibration curve showed that the nomogram model had good discrimination and calibration.Conclusion Programmed epidural intermittent pulse injection of ropivacaine in concentration progressively increasing method has positive effects on controlling perioperative blood glucose stability of the pregnant women with GDM,and exerts obvious analgesic effect.It can shorten labor process and reduce dosage of the drug used,so it is worthy to be applied broadly in clinic.