摘要
目的探究硬膜外不同给药方法对初产妇分娩镇痛效果、认知功能及新生儿的影响。方法2019年1—12月安徽省铜陵市妇幼保健院产科接受硬膜外分娩镇痛的初产妇92例,随机分为规律间断给药组和持续给药组,每组各46例;比较两组产妇的疼痛程度、麻醉药物用量、产程、分娩方式、不良反应发生情况及新生儿出生情况;同时于给药前和给药后24h,采用蒙特利尔认知评估(Montreal Cognitive Assessment,MoCA)量表评价产妇给药前后的认知功能,并采用酶联免疫吸附法(enzyme-linked immunosorbent assay,ELISA)测定分娩前后产妇血清中的神经元特异性烯醇化酶(neuronspecific enolase,NSE)和β淀粉样蛋白(amyloidβ,Aβ)水平。结果规律间断给药组产妇镇痛后3h和4h疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分低于持续给药组(P<0.05),但两组不同时间点体温的比较,差异无统计学意义(P>0.05);规律间断给药组罗哌卡因和舒芬太尼用量、器械辅助比例均低于持续给药组,差异具有统计学意义(P<0.05);但两组产程时间、剖宫产比例、不良反应发生率、新生儿1min和5min Apgar评分、产后MoCA评分、血清NSE和Aβ水平的比较,差异无统计学意义(P>0.05)。结论硬膜外规律间断给药镇痛效果与持续给药相比,对减轻产妇疼痛、帮助胎儿自然分娩的效果更佳,但不影响产妇认知功能。
Objective To explore the effects of different epidural administration methods on labor analgesic,cognitive function and neonatal outcomes in primipara.Method A total of 92 primiparas who underwent epidural labor analgesia in Obstetrics Department from January to December 2019 were enrolled.Patients were randomly divided into intermittent administration group and continuous administration group with 46 cases in each group.The pain level,dosage of anesthetic drugs,labor stage,delivery mode,adverse events of primiparas,and neonatal condition were compared between the two groups.Montreal Cognitive Assessment(MoCA)scale was used to evaluate the cognitive function of the primiparas before and after the anesthetic administration.Enzyme-linked immunosorbent assay(ELISA)was used to determine the levels of neuronspecific enolase(NSE)and amyloid β(Aβ)in the serum of primiparas before and after delivery.Result VAS scores at 3h and 4h after analgesia in intermittent administration group were significant lower than those in continuous administration group(P<0.05).However,there was no significant difference in body temperature of different time between the two groups(P>0.05).The dosages of ropivacaine and sufentanil,and proportion of device assistance in intermittent administration group were significant lower than those in continuous administration group(P<0.05).There were no significant differences in time of labor stage,proportion of cesarean section,incidence of adverse events,Apgar scores of 1 min and 5 min,postpartum MoCA scores,serum NSE and Aβlevels between the two groups(P>0.05).Conclusion Compared with continuous administration,the effect of intermittent epidural administration is better for maternal pain alleviation and natural delivery,without cognitive influence.
作者
吴焘
魏巍
Wu Tao;Wei Wei(Department of Anesthesiology,Tongling Maternal and Child Health Hospital,Tongling 244000,Anhui,China;Department of Obstetrics and Gynecology,Tongling Maternal and Child Health Hospital,Tongling 244000,Anhui,China)
出处
《中国医学前沿杂志（电子版）》
2022年第3期14-18,共5页
Chinese Journal of the Frontiers of Medical Science(Electronic Version)
基金
铜陵市卫生计生委2016年科研立项项目——剖宫产术后阴道试产研究(卫科研〔2016〕10号)。
关键词
硬膜外分娩镇痛
间断给药
初产妇
认知功能
新生儿
Labor epidural analgesia
Intermittent administration
Primiparas
Cognitive function
Neonate
