Abstract:

Objective　To observe the analgesic effects and safety of ropivacaine and sufentanil during the rebirth of scarred uterus in the free body position. Methods　It was a randomized controlled trial. A total of 110 re-pregnancy patients with scarred uterus admitted to Maternal and Child Health Hospital of Jiaozuo City from March 2021 to March 2022 were selected as the research objects, and they were divided into group A [55 cases, with an age of (30.23±0.16) years old] and group B [55 cases, with an age of (30.11±0.35) years old] according to the proportion of 1∶1 by drawing lots. Both groups were given birth analgesia in the free body position. Group A was given ropivacaine for analgesia, and group B was given sufentanil. The analgesic effects, pregnancy outcomes, and prognosis of the two groups were compared. χ² test and independent sample t test were used. Results　Under different analgesia modes, the Visual Analog Scale (VAS) scores in group A 10 min, 30 min, 60 min, and 90 min after analgesia [(5.72±0.31) points, (5.04±0.33) points, (4.45±0.31) points, and (3.66±0.41) points] were slightly lower than those in group B [(5.75±0.28) points, (5.05±0.26) points, (4.52±0.28) points, and (3.72±0.36) points], but there were no statistically significant differences (all P>0.05). The level of malondialdehyde (MDA) in group A was lower than that in group B [(411.36±10.15) nmol/ml vs. (435.47±10.38) nmol/ml] (t=12.316, P<0.001), but the level of superoxide dismutase (SOD) was higher than that in group B [(385.32±10.16) U/L vs. (341.36±10.31) U/L] (t=22.523, P<0.001). The neonatal Apgar scores in group A 1 min, 5 min, and 10 min after birth [(8.33±0.16) points, (8.85±0.47) points, and (9.11±0.46) points] were higher than those in group B [(7.64±0.28) points, (8.23±0.16) points, and (8.82±0.41) points], with statistically significant differences (all P<0.05). The incidence of adverse prognosis in group A was 9.09% (5/55), which was lower than that in group B [21.82% (12/55)] (χ²=6.201, P=0.013). Conclusion　The analgesic effects of ropivacaine and sufentanil on re-pregnant women with scarred uterus in the free body position are similar, but in contrast, the stress response of ropivacaine used in intravenous patient-controlled analgesia pump is lighter, the safety is higher, and it is more positive in improving the maternal and infant outcomes.

Key words:

Scarred uterus, Re-pregnancy, Free body position, Ropivacaine, Sufentanil, Analgesic effect, Safety

摘要：

目的　观察自由体位下应用罗哌卡因、舒芬太尼对瘢痕子宫再次分娩的镇痛效果及安全性。方法　本研究为随机对照试验。选取2021年3月至2022年3月期间焦作市妇幼保健院收治的110例瘢痕子宫再次妊娠患者为研究对象，经抽签法将患者按1∶1比例分为A组［55例，年龄（30.23±0.16）岁］、B组［55例，年龄（30.11±0.35）岁］。两组均在自由体位下进行分娩镇痛，A组采用罗哌卡因镇痛，B组采用舒芬太尼镇痛。比较两组的镇痛效果、妊娠结局及预后情况。行χ²检验、独立样本t检验。结果　在不同镇痛方式下，A组镇痛10 min、30 min、60 min、90 min后的视觉模拟疼痛评分量表（VAS）评分［（5.72±0.31）分、（5.04±0.33）分、（4.45±0.31）分、（3.66±0.41）分］略低于B组［（5.75±0.28）分、（5.05±0.26）分、（4.52±0.28）分、（3.72±0.36）分］，但差异均无统计学意义（均P>0.05）。镇痛后A组患者的丙二醛（MDA）水平（411.36±10.15）nmol/ml低于B组（435.47±10.38）nmol/ml（t=12.316，P<0.001）、超氧化物歧化酶（SOD）水平（385.32±10.16）U/L高于B组（341.36±10.31）U/L（t=22.523，P<0.001）。A组新生儿娩出后1 min、5 min、10 min时的Apgar评分［（8.33±0.16）分、（8.85±0.47）分、（9.11±0.46）分］高于B组［（7.64±0.28）分、（8.23±0.16）分、（8.82±0.41）分］，差异均有统计学意义（均P<0.05）。A组不良预后发生率9.09%（5/55）低于B组21.82%（12/55）（χ²=6.201，P=0.013）。结论　自由体位下对瘢痕子宫再次妊娠产妇实施罗哌卡因、舒芬太尼镇痛的效果相当，但相比之下，在静脉自控镇痛泵中应用罗哌卡因的应激反应更轻，安全性更高，对改善母婴结局更具积极意义。

关键词:

瘢痕子宫, 再次妊娠, 自由体位, 罗哌卡因, 舒芬太尼, 镇痛效果, 安全性