摘要
目的评价硬膜外分娩镇痛对新生儿氧合状态的影响。方法选择初产妇60例,年龄22～33岁,ASAⅠ或Ⅱ级,足月单胎头位妊娠,将自愿接受硬膜外分娩镇痛的产妇分至E组,自愿放弃分娩镇痛的产妇分至S组,每组30例。E组:宫口开至3cm时,于L_(2-3)椎间隙行硬膜外穿刺,注入试验剂量1%利多卡因3ml,观察3～5min,注入0.1%罗哌卡因与0.25μg/ml舒芬太尼的混合液8～12ml作为首剂量,获得满意镇痛效果后接PCA泵,背景输注速率8～12ml/h,PCA量3～5ml,锁定时间30min,最大量20ml/h,胎儿胎盘娩出,缝合伤口全部结束后停药拔管。S组:按常规自然分娩程序处理。记录产妇宫口开3、6、8、10cm时VAS疼痛评分;记录新生儿出生后1、5min时Apgar评分;记录脐动脉血气分析及血清乳酸浓度;采用ELISA法测定脐动脉血中脐血中缺血修饰白蛋白(ischemia modified albumin,IMA)、白蛋白浓度。结果产妇宫口开6、8、10cm时E组VAS评分明显低于S组(P<0.05)。两组新生儿Apgar评分、脐动脉血气分析、血清乳酸浓度和脐动脉血IMA浓度、白蛋白浓度以及IMA/白蛋白比值差异无统计学意义。结论硬膜外分娩镇痛对脐血IMA浓度以及新生儿氧合无影响,且镇痛效果确切,是一种安全有效的分娩镇痛方法。
Objective To evaluate the effect of epidural anesthesia for labor analgesia on the level of ischemia modified albumin(IMA)in umbilical cord blood.Methods Sixty primiparas,aged 22-33 years,falling into ASA physical statusⅠ orⅡ,with a single fetus at full term lying in a normal headdown position were elected.The primiparas who met the standard voluntary epidural analgesia were assigned to group E,the primiparas who voluntarily gave up labor analgesia were divided into group S(n=30each).When the cervical dilation opened to 3cm,the epidural puncture was performed in the L2-3intervertebral space in group E.An epidural catheter was placed at the head end,and the experimental dose of 1% lidocaine was injected,and then 8-12 ml of the mixture of 0.1% ropivacaine with 0.25μg/ml sufentanil was injected as the first dose to obtain a satisfactory effect followed by PCA pump.The background infusion rate was 8-12ml/h,PCA volume 3-5ml,locking time 30 minutes,the maximum amount of 20 ml per hour,fetal placenta delivered,suture wounds completed followed by the withdrawal of the tube.Conventional natural delivery procedures was performed in group S.VAS scores of maternal cervix at 3,6,8,and 10 cm,the Apgar scores at 1 and 5min after birth,the umbilical arterial blood gas analysis and serum lactate concentration were recorded;The IMA and albumin concentrations in the umbilical arterial blood was measured by the ELISA method.Results The VAS score in group E after labor analgesia was significantly lower than that in group S(P < 0.05).There were no significant differences in Apgar score,umbilical arterial blood gas analysis,serum lactate concentration,umbilical arterial blood IMA,albumin concentration and IMA/albumin ratio between the two groups.Conclusion Epidural labor analgesia has no effect on the level of IMA in cord blood and neonatal oxygenation.Meanwhile,the analgesic effect of epidural labor analgesia is exact.It is a safe and effective method of labor analgesia.
作者
弓利豪
杨保仲
GONG Lihao;YANG Baozhong(Department of Anesthesiology,Shanxi Medical University,Taiyuan 030001,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2018年第12期1161-1163,共3页
Journal of Clinical Anesthesiology
基金
晋中市科技重点研发计划(Y173001)
关键词
硬膜外阻滞
分娩镇痛
缺血修饰白蛋白
白蛋白
Epidural anesthesia
Labor analgesia
Ischemia modified albumin
Albumin
