氢吗啡酮与罗哌卡因硬膜外分娩镇痛对初产妇疼痛应激及产程的影响

Effect of epidural labor analgesia with oxymorphone and ropivacaine on pain stress and labor stage in primiparas

目的 观察氢吗啡酮与罗哌卡因硬膜外分娩镇痛对初产妇疼痛应激、产程及温度感受器的影响。方法 将进行分娩镇痛的初产妇按照不同的麻醉镇痛方式分为氢吗啡酮组和罗哌卡因组。氢吗啡酮组予以40μg·mL^(-1)盐酸氢吗啡酮硬膜外自控镇痛(PCEA),罗哌卡因组予以0.1%罗哌卡因PCEA。记录2组初产妇疼痛应激、产程、产时发热、镇痛泵有效按压次数和总次数、新生儿阿氏评分,观察2组的药物不良反应发生情况。结果 氢吗啡酮组42例,罗哌卡因组48例。镇痛后,氢吗啡酮组与罗哌卡因组宫口开全(T3)的视觉模拟评分(VAS)分别为(2.68±0.37)和(3.08±0.52)分,胎儿娩出后(T4)VAS分别为(3.12±0.31)和(4.15±0.26)分,胎盘娩出后1 h(T5)VAS分别为(1.36±0.13)和(1.45±0.12)分,差异均有统计学意义(均P<0.05)。氢吗啡酮组与罗哌卡因组镇痛后30 min(T2)血清皮质醇(Cor)分别为(276.69±25.74)和(289.64±24.52)nmol·L^(-1),血清NE分别为(2.21±0.17)和(2.39±0.11)pg·mL^(-1);胎儿娩出后(T4)血清Cor分别为(146.36±18.97)和(202.83±22.68)nmol·L^(-1),血清NE分别为(1.71±0.19)和(1.95±0.16)pg·mL^(-1),差异均有统计学意义(均P<0.05)。氢吗啡酮组与罗哌卡因组总产程时间分别为(573.26±162.37)和(566.38±171.45)min,差异无统计学意义(P>0.05)。氢吗啡酮组与罗哌卡因组产时发热发生率分别为4.76%和18.75%,差异有统计学意义(P<0.05)。氢吗啡酮组与罗哌卡因组镇痛泵有效按压次数分别为(6.18±1.12)和(7.19±1.23)次,总按压次数分别为(6.52±1.69)和(7.81±1.74)次,差异均有统计学意义(均P<0.05)。氢吗啡酮组与罗哌卡因组新生儿出生1 min阿氏评分分别为(9.21±0.26)和(9.19±0.24)分,出生5 min阿氏评分分别为(9.56±0.12)和(9.53±0.19)分,差异均无统计学意义(均P>0.05)。氢吗啡酮组与罗哌卡因组恶心发生率分别为23.81%和6.25%,呕吐发生率分别为21.43%和4.17%,头晕发生率分别为17.39%和4.17%,差异均有统计学意义(均P<0.05)。结论 氢吗啡酮比罗哌卡因对初产妇分娩镇痛的镇痛效果较好,可有效降低疼痛应激,且对产妇温度感受器影响较小,不影响产程和新生儿结局。但氢吗啡酮药物不良反应发生率较罗哌卡因高。

Objective To observe the effects of epidural labor analgesia with oxymorphone and ropivacaine on pain stress,labor stage and temperature receptor in primiparas.Methods According to different analgesia methods,primiparas under went labor analgesia were divided into oxymorphone group and ropivacaine group.The oxymorphone group was given 40 μg·mL^(-1) oxymorphone hydrochloride for patient-controlled epidural analgesia(PCEA),while ropivacaine group was given 0.1% of ropivacaine for PCEA.The pain stress,labor stage,intrapartum fever,effective pressure times and total times of analgesic pump,and neonatal Apgar score in the two groups were recorded.The adverse reactions in the two groups were observed.Results There were 42 cases in oxymorphone group and 48 cases in ropivacaine group.After analgesia,scores of visual analogue scale(VAS) in oxymorphone group and ropivacaine group immediately after uterine complete opening(T3) were(2.68±0.37) and(3.08±0.52) points,VAS scores after fetal delivery(T4)were(3.12±0.31) and(4.15±0.26) points,VAS scores at 1 h after placenta delivery(T5) were(1.36±0.13)and(1.45±0.12) points,and the differences were statistically significant.In oxymorphone and ropivacaine groups at30 min after analgesia,levels of serum cortisol(Cor) were(276.69±25.74) and(289.64±24.52) nmol·L^(-1),and levels of serum norepinephrine(NE) were(2.21±0.17) and(2.39±0.11) pg·mL^(-1),respectively.At T4,levels of serum Cor in oxymorphone and ropivacaine groups were(146.36±18.97) and(202.83±22.68) nmol·L^(-1),levels of serum NE were(1.71±0.19) and(1.95±0.16) pg·mL^(-1),the differences were all statistically significant(all P <0.05).The total labor stage in oxymorphone group and ropivacaine group were(573.26±162.37) and(566.38±171.45) min,the difference was not statistically significant(P>0.05).The incidence of intrapartum fever in oxymorphone group and ropivacaine group were 4.76% and 18.75%,the differences were statistically significant(P <0.05).The effective pressure times of analgesic pump in oxymorphone group and ropivacaine group were(6.18±1.12) and(7.19±1.23) times,total pressure times were(6.52±1.69) and(7.81±1.74) times,the differences were all statistically significant(all P <0.05).The neonatal 1 min Apgar scores in oxymorphone group and ropivacaine group were(9.21±0.26) and(9.19±0.24) points,5 min Apgar scores were(9.56±0.12) and(9.53±0.19) points,the difference was not statistically significant(P> 0.05).The incidence rates of nausea in hydromorphone group and ropivacaine group were 23.81% and 6.25%,vomiting were 21.43% and 4.17%,dizziness were 17.39% and 4.17%,the differences were statistically significant(all P <0.05).Conclusion Compared with ropivacaine,oxymorphone has better analgesic effect in primiparas,which can effectively reduce pain stress,has fewer effects on temperature receptors and will not affect labor stage and neonatal outcomes.But oxymorphone has higher incidence of adverse drug reactions than ropivacaine.