摘要
目的:探究罗哌卡因程控硬膜外间歇脉冲注入(PIEB)浓度递增用于足月妊娠初产妇分娩自控镇痛(PCEA)效果。方法:选择2020年10月-2023年10月本院收治的单胎、足月妊娠拟行硬膜外分娩镇痛初产妇126例,均接受罗哌卡因硬膜外注射麻醉,根据简单化随机分组将产妇分为固定组(n=63,罗哌卡因+舒芬太尼持续固定背景输入)与递增组(n=63,罗哌卡因+舒芬太尼浓度递增法输入)。对比两组围产期指标,于镇痛前(T0),镇痛后30 min(T1),镇痛后1h(T2),镇痛后2h(T3),宫口开全时(T4),胎儿娩出时(T5)评估两组疼痛评分(VAS)、下肢运动神经阻滞程度(Bromage)评分与镇静评分(Ramsay),胎儿娩出脐动脉血气pH、剩余碱值(BE)、新生儿Apgar评分,药物不良反应。结果:递增组产妇第一产程、第二产程、出血量、PCEA追加次数、罗哌卡因用量、产钳率均低于固定组(均P<0.05),两组第三产程、镇痛时间、顺产率无差异(P>0.05);两组VAS呈先降后升趋势,T4、T5时递增组VAS评分(3.95±0.32分、4.35±0.52分)均低于固定组(4.33±0.50分、4.83±0.60分)(P<0.05);Bromage两组呈上升趋势,但T2~T5时递增组Bromage评分均低于固定组(P<0.05);两组Ramsay呈先升后降趋势,T2~T5时递增组Ramsay评分均高于固定组(P<0.05);两组胎儿脐动脉血气pH、BE及娩出1min时Apgar评分均无差异(P>0.05);两组药物不良反应(4.8%、7.9%)无差异(P>0.05)。结论:罗哌卡因PIEB浓度递增可对足月妊娠初产妇分娩产生良好镇痛镇静效果,稳定产妇生命体征,未增加不良反应。
Objective:To explore the effect of the increasing concentration of ropivacaine programmed intermittent epidural bolus(PIEB)by patient-controlled epidural analgesia(PCEA)for primiparas with full-term pregnancy.Methods:From October 2020 to October 2023,126 primiparas with singleton and full-term pregnancy who had scheduled for epidural labor analgesia were selected and were received epidural injection anesthesia with ropivacaine.According to the simplified random grouping(odd-even number method),these primiparas were divided into two groups(63 cases in each group).The primiparas in the control group were given opivacaine and sufentanil with the continuous fixed concentration infusion,and the primiparas in the study group were given ropivacaine and sufentanil with the increasing concentration infusion.The perinatal indexes of the primiparas were compared between the two groups.Before analgesia(T0),at 30 min after analgesia(T1),at 1 h after analgesia(T2),at 2 h after analgesia(T3),at full cervix opening(T4)and at fetal delivery(T5),the scores of the pain degree evaluated by visual analogue scale(VAS),the lower limb motor nerve block degree evaluated by Bromage and the sedation situation evaluated by Ramsay of the primiparas in the two groups were evaluated.The values of the umbilical artery blood gas pH,base excess(BE)and neonatal Apgar score of the primiparas at fetal delivery and the adverse drug reactions rate of the primiparas in the two groups were also evaluated,Results:The duration of the first stage or the second stage of labor,the blood loss,the additional times of PCEA,the ropivacaine dosage and the forceps delivery rate of the primiparas in the study group were significantly lower than those of the primiparas in the control group(all P<0.05).There were no significant differences in the duration of the third stage of labor,the analgesia time and the spontaneous labor rate of the primiparas between the two groups(P>0.05).The VAS score of the primiparas in the two groups had decreased first and then increased significantly.The VAS scores of the primiparas in the study group at T4 and at T5(3.95±0.32 points and 4.35±0.52 points)of the primiparas were significantly lower than those(4.33±0.50 points and 4.83±0.60 points)of the primiparas in the control group(P<0.05).The Bromage score of the primiparas in the two groups had showed an upward trend,but the Bromage score of the primiparas in the study group at T2-T5 was significantly lower than that of the primiparas in the control group(P<0.05).The Ramsay scores of the primiparas in the two groups had increased first and then decreased significantly,and which of the primiparas in the study group at T2-T5 were significantly higher than those of the primiparas in the control group(P<0.05).There were no significant differences in the values of the umbilical artery blood gas pH and BE,and the Apgar score at lmin after birth of the newborns between the two groups(P>0.05).There was no significant difference in the adverse drug reactions rate(4.8%vs.7.9%)of the primiparas between the two groups(P>0.05),Conclusion:The increasing concentration of ropivacaine used in PIEB for the primiparas with singleton and full-term pregnancy have the good anesthetic effect,and which can stabilize the maternal signs,and with few adverse reactions.
作者
张淑娟
李放
宋琳琳
王震生
ZHANG Shujuan;LI Fang;SONG Linlin;WANG Zhensheng(The Second People's Hospital of Hengshui City,Hengshui,Hebei Province,053000)
出处
《中国计划生育学杂志》
2025年第6期1295-1300,共6页
Chinese Journal of Family Planning
关键词
初产妇
足月妊娠
罗哌卡因
程控硬膜外间歇脉冲注入
浓度递增
自控镇痛
镇痛镇静效果
Primipara
Full-term pregnancy
Ropivacaine
Programmed intermittent epidural bolus
Increasing concentration
Patient-controlled analgesia
Analgesic and sedative effect
