罗哌卡因不同给药方式对妊高症产妇分娩镇痛的影响观察

Effect of Different Administration Methods of Ropivacaine on Labor Analgesia in Parturients with Gestational Hypertension

目的:观察罗哌卡因连续硬膜外麻醉或腰硬联合麻醉用于妊高症产妇分娩镇痛的效果及安全性。方法:行分娩镇痛妊高症产妇164例按入院时间顺序分为E组(硬膜外镇痛组)和SE组(腰硬联合镇痛组),每组82例。记录两组产妇分娩镇痛前即刻(T0)、镇痛后5 min(T1)、镇痛后10 min(T2)、镇痛后30 min(T3)、镇痛后1 h(T4)、镇痛后2 h(T5)、宫口开全(T6)时的疼痛视觉模拟评分(VAS)评分及平均动脉压(MAP)。比较两组产妇的产程时间、分娩方式、催产素使用率、降压药使用率、产后出血率、镇痛起效时间、镇痛时间、产妇满意度、改良Bromage评分、新生儿Apgar评分、新生儿体重及脐带血罗哌卡因浓度。结果:两组产妇T1～T6时VAS评分均较T0时下降(P<0.05),SE组T1～T6时MAP较T0时下降(P<0.05)。SE组T1、T2时VAS评分低于E组(P<0.05),T1、T2、T3时MAP低于E组(P<0.05)。两组产妇第一和第二产程时间、分娩方式、降压药使用率、产后出血率差异均无统计学意义(P>0.05)。SE组催产素使用率高于E组(P<0.05)。SE组镇痛起效时间短于E组(P<0.05);两组镇痛时间、产妇满意度及改良Bromage评分≤1分比例差异无统计学意义(P>0.05)。两组新生儿1 min Apgar评分和5 min Apgar评分,新生儿体重及脐带血罗哌卡因浓度等差异无统计学意义(P>0.05)。两组产妇药品不良反应发生率差异无统计学意义(P>0.05),均无严重不良反应发生。结论:连续硬膜外麻醉和腰硬联合麻醉均可提供满意、安全的镇痛效果。与腰硬联合麻醉相比,连续硬膜外麻醉用于妊高症产妇的分娩镇痛,对血流动力学和子宫收缩的影响较小。

Objective:To observe the efficacy and safety of continuous epidural anesthesia and combined spinal-epidural anesthesia in parturients with gestational hypertension for labor analgesia.Methods:164 cases of parturients with gestational hypertension for labor analgesia were divided into group E(with continuous epidural anesthesia,n=82)and group SE(with combined spinal-epidural anesthesia,n=82)according to the time of admission.Visual analogue score(VAS)and mean arterial pressure(MAP)before analgesia(T0),5 min after analgesia(T1),10 min after analgesia(T2),30 min after analgesia(T3),1 h after analgesia(T4),2 h after analgesia(T5),and when the uterine cervix dilated absolutely(T6)were recorded in the two groups.Labor time,way of delivery,oxytocin utilization rate,blood pressure medication utilization rate,rate of postpartum hemorrhage,analgesic effect time,analgesia time,maternal satisfaction,modified Bromage score,neonatal Apgar score,birth weight and ropivacaine concentration in umbilical cord blood were compared between two groups.Results:VAS scores at T1-T6 were lower than that at T0 in the two groups(P<0.05).MAP at T1-T6 decreased than that at T0 in group SE(P<0.05).VAS scores at T1 and T2 in group SE were lower than those in group E(P<0.05),and MAP at T1,T2 and T3 were lower than those in group E(P<0.05).There were no statistical differences between the first and second labor period,delivery mode,antihypertensive drugs and postpartum bleeding rate in the two groups(P>0.05).The use of oxytocin in group SE was higher than that in group E(P<0.05).Compared with group E,the analgesic effect of the SE group was short(P<0.05),but there were no statistical differences between analgesic time,maternal satisfaction and improved Bromage score in the two groups(P>0.05).Apgar score at 1 min,Apgar score at 5 min,neonatal weight and concentration of ropivacaine in umbilical cord blood showed no significant difference between the two groups(P>0.05).There was no significant difference in the incidence of adverse drug reactions between the two groups(P>0.05),and no serious adverse reactions occurred.Conclusion:Continuous epidural anesthesia and combined spinal-epidural anesthesia can provide satisfactory and safe analgesic effect.Compared with combined spinal-epidural anesthesia,continuous epidural anesthesia had little effect on hemodynamics and uterine contractions in parturients with gestational hypertension for labor analgesia.