妊娠期高血压疾病患者无痛分娩中麻醉应用效果比较  

Effect comparison of anesthesia methods used in painless delivery of patients with pregnancy induced hypertension

作　　者：可焱[1] 郑凌[1] 

机构地区：[1]陕西省西安市第四医院麻醉科,陕西西安710004

出　　处：《中国妇幼健康研究》2017年第11期1454-1457,共4页Chinese Journal of Woman and Child Health Research

摘　　要：目的探讨低浓度舒芬太尼复合0.1%罗哌卡因腰硬联合麻醉(CSEA)+自控硬膜外镇痛泵(PCEA)在妊娠期高血压疾病患者无痛分娩中的应用效果。方法选择陕西省西安市第四医院2016年6月至2017年2月119例妊娠期高血压疾病产妇随机分为3组,先椎管内单纯预注不同浓度的舒芬太尼,A组37例0μg/mL、B组42例0.4μg/mL、C组40例0.6μg/mL,后用舒芬太尼复合0.1%罗哌卡因行PCEA。比较三组镇痛前、镇痛后10min、20min、30min视觉模拟评分(VAS)评分,第一、二产程的时间及血压变化,产后1h内出血量,剖宫产率,先兆子痫和不良反应发生率及新生儿Apgar评分。结果三组镇痛后各时间点VAS评分比较差异均有统计学意义(F值分别为6.138、10.142、3.341、5.883,均P<0.05),B组镇痛后10min、20minVAS评分与A组比较差异均有统计学意义(t值分别为3.525、9.418,均P<0.05),镇痛后30min、宫口开全与A组比较差异无统计学意义(P>0.05);C组镇痛后10min、20min、30min VAS评分与A组差异有统计学意义(t值分别为5.376、13.650、2.365,均P<0.05),宫口开全与A组比较差异无统计学意义(P>0.05);B组与C组镇痛后各时间点比较差异均无统计学意义(均P>0.05)。三组第一产程收缩压、舒张压比较差异均有统计学意义(F分别为7.119、6.202,均P<0.05),B、C组与A组比较差异均有统计学意义(t值分别为12.989、7.536;13.650、6.281,均P<0.05),B组与C组比较差异均无统计学意义(均P>0.05);三组第二产程收缩压、舒张压比较差异均有统计学意义(F分别为6.703、5.113,均P<0.05),B、C组与A组比较差异均有统计学意义(t值分别为6.938、8.627;7.489、7.343,均P<0.05),B组与C组比较差异均无统计学意义(t值分别为0.115、0.042,均P>0.05)。三组第一、二产程时间、产后1h内出血量比较差异均有统计学意义(F值分别为2.572、4.589、2.664,均P<0.05),且剖宫产率比较差异有统计学意义(χ~2=8.438,P<0.05),A组均最高。C组恶心呕Objective To investigate the effect of combined spinal epidural anesthesia（CSEA）with low dose of sufentanil combined with 0.1% ropivacaine and patient-controlled epidural analgesia（PCEA）pump in painless delivery of patients with pregnancy induced hypertension.Methods Altogether 119 women with pregnancy induced hypertension were enrolled and randomly divided into 3 groups.Patients were firstly injected with different concentrations of sufentanil in spinal canal,with 0 ug/ml for 37 cases in group A,0.4 ug/ml for 42 cases in group B and 0.6 ug/ml for 40 cases in group C.Then PCEA with sufentanil combined with 0.1% ropivacaine was conducted.Three groups were compared in terms of visual analogue scale（VAS）score before analgesia and at10 min,20 min and 30 min after analgesia,duration of first and second stages of labor and blood pressure change,bleeding volume at1 hafter delivery,cesarean section rate,incidence of preeclampsia and adverse reactions,and neonatal Apgar score.Results Difference in VAS score at each time point after analgesia in three groups was statistically significant（Fvalue was 6.138,10.142,3.341 and 5.883,respectively all P〈0.05）.VAS score at 10 min and 20 min after analgesia in group B had statistically significant difference compared with that in group A（t value was 3.525 and 9.418,respectively,both P〈0.05）,and that at 30 min after analgesia and at uterus open to full extent in group B was not significantly different from that in group A（t value was 0.417 and0.773,respectively,both P〈0.05）.VAS score at 10 min,20 min and 30 min after analgesia in group C was significantly different compared with that in group A（t value was 5.376,13.650 and 2.365,respectively,all P〈0.05）,while that at uterus open to full extent in group C was not significantly different compared with that in group A（t=0.946,P〈0.05）.There was no significant difference between group B and group C at each time point after analgesia（t value was 0.176,0.942,1.103,0.663 and 0.274,respectively,all

关 键 词：舒芬太尼 罗哌卡因 腰硬联合麻醉 自控硬膜外镇痛泵 妊娠期高血压疾病 

分 类 号：R714.2[医药卫生—妇产科学]