罗哌卡因联合舒芬太尼对妊娠高血压患者无痛分娩的影响

Effect of ropivacaine combined with sufentanil on painless delivery of patients with pregnancy induced hypertension

目的探讨罗哌卡因联合舒芬太尼对妊娠高血压患者无痛分娩应激状况、妊娠结局的影响。方法选取温岭市妇幼保健院2015年6月至2017年12月收治的患妊娠高血压并选择无痛分娩产妇110例,利用随机数字表法将其分成对照组与观察组各55例。对照组采用氯普鲁卡因联合芬太尼镇痛,观察组采用罗哌卡因联合舒芬太尼镇痛。观察两组各时点即镇痛前(T_0)、镇痛后30min(T_1)、镇痛后60min(T_2)、宫口开6cm(T_3)、宫口开全(T_4)、分娩后30min(T_5)的心率(HR)、舒张压(DBP)、收缩压(SBP)、血氧饱和度(SpO_2)变化情况,采用血气分析仪测定胎儿脐动脉血pH值、乳酸值。根据新生儿阿氏评分(Apgar)标准对新生儿进行评分,记录新生儿窒息、宫内窘迫发生率,并记录两组镇痛后不良反应发生率。结果两组T_0时的HR、DBP、SBP、SpO_2比较均无统计学差异(均P>0.05),两组T_1、T_2时各指标水平显著低于T_0、T_3、T_4、T_5(观察组:t=1.86～28.47,均P<0.05;对照组:t=2.09～25.22,均P<0.05),两组T_3时的各指标水平低于T_4、T_5,且T_4时的HR、DBP、SBP低于T_5,差异均有统计学意义(观察组:t值分别为2.55、6.52、6.09,均P<0.05;对照组:t值分别为4.59、2.00、2.02,均P<0.05),观察组T_3、T_4时的HR高于对照组,DBP、SBP低于对照组,组间比较差异显著(HR:t值分别为3.20、2.03;DBP:t值分别为4.64、5.83;SBP:t值分别为7.95、5.71,均P<0.05)。观察组出生后1min、5min、10min的新生儿Apgar评分均较对照组更高,差异均有统计学意义(t值分别为2.62、3.04、2.73,均P<0.05)。观察组新生儿窒息、胎儿宫内窘迫发生率均为1.82%,对照组分别为5.45%、3.64%,组间比较无显著差异(均P>0.05)。两组恶心、呕吐、寒战、感觉异常、头晕、低血压发生率比较均未见显著差异(均P>0.05)。结论罗哌卡因联合舒芬太尼能控制妊娠高血压产妇的血压水平,给药安全可靠,值得临床推广。

Objective To investigate the effects of ropivacaine combined with sufentanil on stress status and pregnancy outcomes in painless delivery of patients with pregnancy induced hypertension.Methods One hundred and ten pregnant women with pregnancy induced hypertension and accepting painless childbirth were selected in Wenling Maternal and Child Health Care Hospital from June 2015 to December 2017,and they were divided into control group and observation group by random number table method with 55 cases in each.The control group was treated with chlorprocaine and fentanyl,and the observation group was treated with ropivacaine and sufentanil.Heart rate(HR),diastolic blood pressure(DBP),systolic blood pressure(SBP),and blood oxygen saturation(SpO2)changes were observed in two groups before analgesia(T0),30 min after analgesia(T1),60 min after analgesia(T2),cervix opening for 6 cm(T3),full dilatation(T4),and 30 min after delivery(T5).Blood gas analyzer was used to determine fetal umbilical artery pH value and lactate level.According to neonatal Apgar standard,we scored the neonates,recorded the incidence of neonatal asphyxia and intrauterine distress,and recorded the incidence of adverse reactions after analgesia in two groups.Results There was no significant difference in HR,DBP,SBP and SpO2 in two groups at T0(P>0.05).Each index in two groups was significantly lower at T1 and T2 than at T0 T3,T4 and T5(observation group:t value ranged 1.86-28.47,all P<0.05;control group:t value ranged 2.09-25.22,all P<0.05).Each index at T3 was lower than that at T4 and T5,and HR,DBP and SBP at T4 were lower than those at T5 with statistical significance(observation group:t value was 2.55,6.52 and 6.09,respectively,all P<0.05;control group:t value was 4.59,2.00 and 2.02,respectively,all P<0.05).The HR of T3 and T4 in the observation group was higher than that in the control group,but DBP and SBP were lower with significant differences(HR:t value was 3.20 and 2.03;DBP:t value was 4.64 and 5.83;SBP:t value was 7.95 and 5.71,respectively,all P<0.05).At 1 min,5 min and 10 min after birth,the Apgar scores of the newborn were higher in the observation group than those in the control group,and the differences were significant(t value was 2.62,3.04 and 2.73,respectively,all P<0.05).The incidence of neonatal asphyxia and fetal distress was both 1.82%in the observation group,and it was 5.45%and 3.64%in the control group,respectively.There was no significant difference between two groups(all P>0.05).The differences were not significant in the incidence of nausea,vomiting,chills,abnormal sensation,dizziness and hypotension between two groups(all P>0.05).Conclusion Ropivacaine combined with sufentanil can control the blood pressure in pregnant women with pregnancy induced hypertension.It is safe and reliable,and it is worthy of clinical promotion.