摘要
目的比较0.06%与0.1%的罗哌卡因用于程序化间歇硬膜外给药(Programmed intermittent epidural bolus,PIEB)联合患者自控镇痛(Patient-controlled epidural analgesia,PCEA)进行分娩镇痛在妊娠期高血压疾病患者中的效果。方法选取本院2017年1-12月收治的116例妊娠期高血压疾病孕妇,按随机数表法分为观察组与对照组,各58例。两组均采取PIEB联合PCEA,观察组麻醉方案:0.06%罗哌卡因+0.5μg/ml舒芬太尼,对照组麻醉方案:0.1%罗哌卡因+0.5μg/ml舒芬太尼。比较两组自然分娩率,穿刺前即刻(T0)、给药15 min(T1)、给药30 min(T2)、给药2 h(T3)、宫口开全时(T4)、第二产程中感觉到最大缩宫痛时(T5)的VAS评分,第一产程、第二产程、镇痛持续时间,罗哌卡因消耗量,舒芬太尼消耗量,缩宫素使用率,新生儿1 min Apgar评分<8分发生率,以及不良反应总发生率。结果观察组的自然分娩率为68.97%(40/58),对照组为67.24%(39/58),两组自然分娩率比较差异无统计学意义(P>0.05),最终两组分别纳入40例和39例患儿进行分析。两组不同时点的VAS评分比较差异无统计学意义(P>0.05)。两组第一产程、镇痛持续时间、舒芬太尼消耗量比较差异无统计学意义(P>0.05)。观察组第二产程短于对照组,罗哌卡因消耗量低于对照组,差异有统计学意义(P<0.05)。两组均未见新生儿1 min Apgar评分<8分与运动阻滞。两组缩宫素使用率与不良反应总发生率比较差异无统计学意义(P>0.05)。结论 PIEB联合PCEA下低浓度罗哌卡因(0.06%)联合舒芬太尼(0.5μg/ml)可满足妊娠期高血压疾病产妇的镇痛需求,并可缩短第二产程、减少罗哌卡因用量,对产妇与胎儿均较为安全,与0.1%罗哌卡因+0.5μg/ml舒芬太尼相比更具优势。
Objective To compare the effect of 0.06% and 0.1% ropivacaine for programmed intermittent epidural bolus(PIEB) combined with patient-controlled epidural analgesia(PCEA) on the labor analgesia of patients with on pregnancy-induced hypertension.Methods A total of 116 pregnant women with pregnancy-induced hyperten-si on admitted to our hospital from January to December 2017 were randomly divided into observation group and control group,with 58 cases in each group.Both groups received PIEB combined with PCEA.The anesthesia program of observation group and control group were 0.06% ropivacaine+0.5 μg/ml sufentanil and 0.1% ropivacaine+0.5 μg/ml sufentanil.The natural delivery rate,VAS score immediately before the puncture(T0) and at 15 min(T1), 30 min(T2) and 2 h(T3) after anesthesia, and at the full opening of cervix orifice(T4) and the moment the patients feel the greatest uterine contraction pain during the second stage of labor(T5),the first stage of labor,the second stage of labor,duration of analgesia,consumption of ropivacaine and sufentanil,the rate of oxytocin use,incidence rate of neonatal whose 1 min Apgar score was less than 8 points,and the total incidence of adverse reactions were compared between the two groups.Results The natural delivery rate was 68.97%(40/58) in observation group and 67.24%(39/58) in control group,there was no significant difference between the two groups(P>0.05).Therefore,40 cases in observation group and 39 cases in control group were included in the analysis.There were no significant differences in the pain VAS scores at different time points between the two groups(P>0.05).There were no significant differences in the first stage of labor,duration of analgesia and consumption of sufentanil between the two groups(P>0.05).The second stage of labor in observation group was shorter than that in control group,and the consumption of ropivacaine was lower than that in control group,the differences were statistically significant(P<0.05).No neonatal with 1 min Apgar score<8 points and moto
作者
梁刚
杨月琴
何斌
LIANG Gang;YANG Yue-qin;HE Bin(Department of Anesthesiology,Wenling Maternal and Child Health Care Hospital,Wenling 317500,China)
出处
《实用药物与临床》
CAS
2019年第6期616-620,共5页
Practical Pharmacy and Clinical Remedies
基金
温岭市科技局计划项目(2016C31BE0016)
关键词
分娩镇痛
罗哌卡因
舒芬太尼
程序化间断硬膜外给药
妊娠期高血压
Labor analgesia
Ropivacaine
Sufentanil
Programmed intermittent epidural bolus
Pregnancy-induced hypertension