不同体位硬膜外分娩镇痛低血压发生率及新生儿Apgar评分比较  

Comparison of the hypotension incidence and Apgar scores after epidural labor analgesia at different positions

作　　者：蔡军[1] 于刚[1] 侍海碧[1] 颜建娥[1] 孟茜[1] 武玉清 CAI Jun;YU Gang;SHI Haibi;YAN Jian＇e;MENG Qian;WU Yuqing(Department of Anesthesiology, the Maternal and Child Health Hospital of Lianyungang, Lianyungang, Jiangsu 222006, China;Department of Anesthetic Pharmacology, Xuzhou Medical University, Xuzhou, Jiangsu 221004)

机构地区：[1]连云港市妇幼保健院麻醉科,江苏连云港222006 [2]徐州医科大学麻醉药理学教研室,江苏徐州221004

出　　处：《徐州医科大学学报》2018年第3期171-174,共4页Journal of Xuzhou Medical University

基　　金：连云港市卫计委科研项目（201725）

摘　　要：目的比较0．1％罗哌卡因硬膜外分娩镇痛后仰卧-侧卧结合体位和单纯侧卧位对产妇低血压发生率、镇痛效果及新生儿Apgar评分的影响。方法选择ASAⅠ～Ⅱ级、年龄20—32岁初产妇60例，随机分为仰卧-侧卧位组（A组），侧卧位组（B组），每组30例，镇痛前（L）监测收缩压（SBP）、平均动脉压（MAP）、VAS评分和胎心率，行L2、L3间隙硬膜外穿刺、置管，A组镇痛后采取仰卧10min再侧卧结合体位；B组镇痛后采取侧卧位。而后以0．1％罗哌卡因复合2mg／L芬太尼微量输注泵以8～10ml／h速度维持。分别观察2组产妇镇痛后10min（T1）、30rain（T2）SBP、MAP、VAS评分及镇痛后胎儿心率和新生儿出生后Apgar评分的情况。结果2组产妇镇痛后T1、T2时SBP、MAP较T0时明显降低（P〈0．05）；T1时A组SBP、MAP、SBP波动幅度，MAP波动率均低于B组，差异有统计学意义（P〈0．05）；T1时VAS评分A组明显低于B组，差异有统计学意义（P〈0．05）；而2组仰卧位低血压发生率、胎儿心率和新生儿Apgar评分相比差异无统计学意义（P〉0．05）；A组一、二产程满意度明显高于B组（P〈0．05）。结论硬膜外分娩镇痛后产妇采取仰卧-侧卧结合体位，能明显减少血压波动，且在更短时间达到满意的镇痛效果，提升产妇满意度和信任感。Objective To compare the hypotension incidence, analgesic effects and Apgar scores after epidural la- bor analgesia using 0.1% ropivacaine in the supine - lateral positions and lateral position alone. Methods A total of 60 primiparous aging 20 -32s old, ASA Ⅰ～Ⅱ were randomly divided into two groups （n = 30） ： a supine -lateral position group （Group A ） and a lateral position （Group B ）. Their systolic blood pressure （SBP）, mean arterial pressure （MAP） , VAS scores and fetal heart rates were monitored before anesthesia （TO ）. During epidural labor analgesia at the L2 - L3 interspace, Group A kept in the supine position for 10 min followed by the lateral position, while Group B re- mained in the lateral position. Both groups were administered with a combination of 0.1% ropivacaine and 2 mg/L fenta- nyl at 8 - 10 ml/h for maintenance of anesthesia. Then, SBP, MAP, VAS scores, fetal heart rates and Apgar scores were detected I0 min and 30 min after anesthesia （ T1 and Tz ）. Results Both groups showed remarkable decreases in SBP and MAP at T1 and T2 , compared with those at To （ P 〈 0.05 ）. Group A presented reduced SBP and MAP, SBP fluctua- tion, MAP fluctuation rate, and VAS scores at T1 , compared with Group B （ P 〈 0.05 ）. Meanwhile, no difference was found as to hypotension incidence, fetal heart rates and Apgar scores between the two groups （ P 〉 0.05 ）. Conclusions Epidural labor analgesia in the supine - lateral positions can remarkable reduce blood pressure changes and achieve anes- thetic satisfaction in a short time, which is helpful to enhance patient satisfaction and trust.

关 键 词：体位 硬膜外分娩镇痛 低血压 APGAR评分 

分 类 号：R614[医药卫生—麻醉学]