腰麻-硬膜外联合麻醉及硬膜外自控分娩镇痛始于产程潜伏期与活跃期的比较  

Effects of combined spinal-epidural analgesia and patient controlled epidural labor analgesia in latent and active phase

作　　者：冯忠[1] 岳红丽[2] 丁冠男[1] 李彦平[1] 李树人[1] 

机构地区：[1]首都医科大学附属北京友谊医院麻醉科,100050 [2]首都医科大学附属北京天坛医院麻醉科

出　　处：《中华围产医学杂志》2012年第9期553-558,共6页Chinese Journal of Perinatal Medicine

摘　　要：目的比较腰麻硬膜外联合麻醉及硬膜外自控分娩镇痛始于产程潜伏期与活跃期的临床效果、对母婴应激反应的影响和脐带血中的罗哌卡因浓度。方法将80例于2009年1月至6月在首都医科大学附属北京友谊医院产科分娩且自愿接受分娩镇痛的足月、单胎、头位初产妇，随机分为潜伏期组和活跃期组（各40例），分别于潜伏期（宫口扩张o．5～2．5cm）和活跃期（宫口扩张≥3．ocm）于蛛网膜下腔给予罗哌卡因2mg±芬太尼10μg，随后采用0．1％罗哌卡因±芬太尼2μg／ml硬膜外患者自控镇痛模式开始分娩镇痛，记录视觉模拟评分（visualanaloguescore，VAs）的镇痛评分、下肢肌力、产程时间、分娩方式、药物用量及产妇满意度，检测镇痛前、娩出胎儿即刻产妇静脉血和胎儿娩出后脐带血皮质醇浓度（放射免疫法）及脐带血罗哌卡因浓度（高效液相色谱法）。以同期相同条件不接受分娩镇痛的40例产妇为对照组，采用7。或t检验和方差分析进行统计学比较。结果（1）镇痛后5rain始至宫口开全过程中，潜伏期组和活跃期组VAS评分仅在宫口7．0～8．0cm及宫口开全时低于对照组[宫口7．0～8．0cm：（2．9±1．4）分、（2．6±1．5）分与（9．2±0．7）分，F=201．50，P〈0．01；宫口开全：（4．7±2．2）分、（3．6±2。0）分与（9．1±0．7）分，F=62．07，P〈0．01]。（2）胎儿娩出即刻母体血皮质醇浓度较镇痛前增高，但潜伏期组和活跃期组均比对照组增高幅度小（761±125）μg／L、（731±184）μg／L与（902±172）ttg／L，t=-3．491和-3．483，P均〈0．011，而潜伏期与活跃组2组问差异无统计学意义；3组间脐带血皮质醇浓度差异无统计学意义[（168±46）μg／L、（159±49）btg／L与（170±86）μg／L，F=0．23，P〉0．053。（3）胎儿娩出即刻潜伏期组和活跃期组脐带血罗哌卡因浓度分别为（0．Objective To compare the effects, stress reaction and concentration of ropivacaine in umbilical cord blood of patients who accepted combined spinal-epidural analgesia or patient controlled epidural labor analgesia in latent and active phase. Methods After approved by the ethics committee and informed consents from 80 nulliparous parturients who were admitted to Beijing Friendship Hospital, Capital University of Medical Sciences between January to June 2009, and who were term, single, cephalic presentation delivery and ASA Ⅰ-Ⅱ, were divided into two groupsrandomly： latent phase group （Group L, cervical dilation 0.5-2.5 cm, n=40） and active phase group （Group A, cervical dilation 3.0 cm, n=40）. Ropivacaine 2 mg and fentanyl 10 t＊g was administered in subarachnoid space of all patients. Then, patient controlled epidural infusion of 0.1 0 ropivacaine plus fentanyl 2 μg/ml were administered. Pain scores （visual analogue score, VAS）, lower extremity muscle strength, duration of labor, delivery mode, total dosage used, maternal satisfaction, Apgar score （1 min and 5 min） were evaluated; concentration of ropivacaine （high performance liquid chromategraphy） in cord blood, and concentration of cortisol （radioimmunoassay） in maternal venous blood and cord blood were detected. Forty nulliparous parturients without labor analgesia were taken as control group （Group C）. Chi-square test and one way analysis of variance was applied for statistical analysis. Results （1） VAS in Group L and Group A were lower than that of Group C when cervix dilated at 7.0±8.0 cm （2.9±1.4, 2.6±1.5 vs 9.2±0.7, F= 201.50, P〈0.01） and fully dilated （4.7±2.2, 3.6±2.0 vs 9.1±0.7, F=62.07, P〈0.01, respectively）. （2） The concentration of cortisol in maternal venous blood right after delivery was higher than that before analgesia in all groups, and the change in group C was significantly greater than that in group L and group A [-（902±172）μg/L vs （761±125） p.g/L and （731±184） p

关 键 词：分娩过程 镇痛 产科 镇痛 病人控制 麻醉 硬膜外 麻醉 脊椎 

分 类 号：R714.3[医药卫生—妇产科学]