罗哌卡因穴位注射镇痛在硬膜外分娩镇痛中的作用

The role of acupoint injection of ropivacaine in epidural labor analgesia in latent period

目的评价潜伏期罗哌卡因穴位注射镇痛对硬膜外镇痛疗效、分娩结局及新生儿评分的影响。方法选择无痛分娩的初产妇60例,随机分为两组,每组30例,实验组(L组,n=30)于宫口开至1 cm时穴位注射罗哌卡因,对照组(N组,n=30)则给与生理盐水。两组均于宫口3 cm时行硬膜外阻滞及自控硬膜外镇痛。记录比较穴位注射即刻(T0)、穴位注射后1 h(T1)、穴位注射后2 h(T2)、宫口开到3指(T3)、宫口开全时(T4)的视觉模拟评分(VAS);记录比较两组各产程时间;记录比较两组阴道分娩率、剖宫产率、新生儿Apgar评分情况;记录比较两组镇痛泵按压次数情况;记录两组不良反应发生情况。结果与N组相比,L组T1、T2、T3时刻的VAS评分明显降低;L组镇痛泵PCA按压次数明显少于N组,L组不良反应发生率低于N组,差异有统计学意义。而产程时间、阴道分娩率、剖宫产率、新生儿的Apgar评分差异无统计学意义。结论潜伏期行罗哌卡因的穴位注射镇痛安全、有效,可明显缓解产妇潜伏期的疼痛,与硬膜外阻滞联合镇痛,可加强镇痛效果,且无明显不良反应。

Objective To evaluate the effect of acupoint injection of ropivacaine in latent period on epidural analgesia,delivery outcome and neonatal score,and to provide reference for clinical labor analgesia.Methods 60 primiparas with painless delivery were randomly divided into two groups,30 cases in each group.The experimental group(L group,n=30)was injected with ropivacaine at the acupoint when the cervix was opened to 1cm,while the control group(N group,n=30)was given normal saline.Epidural block and patient-controlled epidural analgesia were performed in both groups when the cervix was 3cm.The visual analogue scale(VAS)was recorded and compared immediately after acupoint injection(T0),1h after acupoint injection(T1),2h after acupoint injection(T2),with the cervix open to three fingers(T3)and the cervix open to four fingers(T4).Record and compare the production process time between two groups.The vaginal delivery rate,cesarean section rate and Apgar score of newborns were compared between the two groups.The times of pressing analgesia pump between the two groups were compared.Record the occurrence of adverse reactions in two groups.Results Compared with group N,the VAS scores of group L at T1,T2 and t3 were significantly lower.The number of PCA presses of analgesia pump in group L was significantly less than that in group N,The incidence of adverse reactions in Group L was significantly lower than that in Group N,and the difference was statistically significant.However,there was no significant difference in production process time,vaginal delivery rate,cesarean section rate and Apgar score of newborns.Conclusion Acupuncture point injection of ropivacaine in the latent period is safe and effective,which can obviously relieve the pain of lying-in women in the latent period.Combined with epidural block,it can enhance the analgesic effect without obvious adverse reactions.