不同剂量罗哌卡因辅助硬膜外麻醉对产妇分娩的镇痛效果研究

doi:10.3760/cma.j.issn.1007-1245.2023.11.011

摘要/Abstract

摘要：

目的　观察不同剂量罗哌卡因辅助硬膜外麻醉在产妇分娩镇痛中的应用效果。方法　本文为前瞻性随机对照试验，病例纳入2021年3月至2022年6月期间平顶山市第一人民医院院内125例产妇为研究对象，所有产妇均实施无痛分娩，经抽签法分为两组，将应用常规剂量罗哌卡因+硬膜外麻醉的62例产妇设为对照组［年龄（29.15±0.33）岁，孕周（37.55±0.23）周，初产妇37例、经产妇25例］，将应用低剂量罗哌卡因+硬膜外麻醉的63例产妇设为观察组［年龄（29.12±0.14）岁，孕周（37.52±0.14）周，初产妇35例、经产妇28例］，比较两组产妇用药后不同时间点的疼痛情况、产程时间、分娩情况及用药安全性。采用χ²检验、Fisher确切概率法、独立样本t检验。结果　两组产妇用药前及用药后30、60、120 min及宫口全开时的视觉模拟疼痛评分法（VAS）评分差异均无统计学意义（均P>0.05）。观察组用药后第一产程（10.35±0.85）h短于对照组（10.77±0.33）h（t=3.631，P<0.001）、第二产程（1.33±0.28）h短于对照组（1.75±0.82）h（t=3.844，P<0.001）。观察组新生儿窒息率3.17%（2/63）低于对照组14.52%（9/62）（χ²=7.720，P=0.005）、缩宫素应用率7.94%（5/63）低于对照组17.74%（11/62）（χ²=4.291，P=0.038）。观察组产后改良Bromage评分（1.23±0.44）分低于对照组（2.12±0.36）分（t=12.366，P<0.001）、24 h内泌乳量（33.15±5.23）ml高于对照组（30.11±5.16）ml（t=3.271，P=0.001），不良反应发生率6.35%（4/63）低于对照组19.35%（12/62）（χ²=4.735，P=0.030）。结论　应用低剂量罗哌卡因辅助硬膜外麻醉的镇痛效果与常规剂量近似，且与常规剂量相比，低剂量用药可缩短产妇产程，对改善分娩情况、避免运动神经阻滞、提高产后泌乳量、减少用药后不良反应均有积极意义。

关键词:

分娩镇痛, 硬膜外麻醉, 罗哌卡因, 疼痛情况, 分娩情况, 不良反应

Abstract:

Objective　To observe the effects of different doses of ropivacaine assisted epidural anesthesia in parturients' labor analgesia. Methods　This was a prospective randomized controlled trial. A total of 125 parturients who underwent painless labor in Pingdingshan First People's Hospital from March 2021 to June 2022 were included into the study. They were divided into two groups by lot drawing. Sixty-two parturients who were given conventional dose ropivacaine + epidural anesthesia were set as the control group, with an age of (29.15±0.33) years old and a gestational age of (37.55±0.23) weeks, including 37 primiparas and 25 multiparas. Sixty-three parturients who were given low-dose ropivacaine + epidural anesthesia were set as the observation group, with an age of (29.12±0.14) years old and a gestational age of (37.52±0.14) weeks, including 35 primiparas and 28 multiparas. The pain at different time points after medication, labor process, delivery, and medication safety were compared between the two groups. χ² test, Fisher exact probability method, and independent sample t test were used. Results　There were no statistically significant differences in the Visual Analogue Scale (VAS) scores between the two groups before medication, 30, 60, and 120 min after medication, and when the uterine orifice was fully opened (all P>0.05). The first stage of labor in the observation group was shorter than that in the control group [(10.35±0.85) h vs. (10.77±0.33) h] (t=3.631, P<0.001), and the second stage of labor was shorter than that in the control group [(1.33±0.28) h vs. (1.75±0.82) h] (t=3.844, P<0.001). The neonatal asphyxia rate of the observation group was lower than that of the control group [3.17% (2/63) vs. 14.52% (9/62)] (χ²=7.720, P=0.005), and the oxytocin application rate was lower than that of the control group [7.94% (5/63) vs. 17.74% (11/62)] (χ²=4.291, P=0.038). The postpartum modified Bromage score in the observation group was lower than that in the control group [(1.23±0.44) vs. (2.12±0.36)] (t=12.366, P<0.001), the amount of milk secreted within 24 h was higher than that in the control group [(33.15±5.23) ml vs. (30.11±5.16) ml] (t=3.271, P=0.001), and the incidence of adverse reactions was lower than that in the control group [6.35% (4/63) vs. 19.35% (12/62)] (χ²=4.735, P=0.030). Conclusions　The analgesic effect of low dose ropivacaine assisted epidural anesthesia is similar to that of conventional dose. Compared with conventional dose, low dose ropivacaine can shorten the parturients' labor process, and is of positive significance in improving the delivery situation, avoiding the motor nerve block, increasing the postpartum lactation, and reducing the adverse reactions after medication.

Key words:

, Labor analgesia, Epidural anesthesia, Ropivacaine, Pain, Delivery conditions, Adverse reactions

邢亚伟.

不同剂量罗哌卡因辅助硬膜外麻醉对产妇分娩的镇痛效果研究 [J]. 国际医药卫生导报, 2023, 29(11): 1528-1532.

Xing Yawei.

Analgesic effects of different doses of ropivacaine assisted epidural anesthesia in parturient delivery [J]. International Medicine and Health Guidance News, 2023, 29(11): 1528-1532.

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