小剂量低浓度罗哌卡因用于妊娠期高血压产妇分娩镇痛的临床研究  

Clinical study on low dose and low concentration of ropivacaine for labor analgesia in parturients with pregnancy-induced hypertension

作　　者：刘野[1] 徐铭军[1] 赵国胜[1] 康凯[1] 白云波[1] Liu Ye;Xu Mingjun;Zhao Guosheng;Kang Kai;Bai Yunbo(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing 100026,China)

机构地区：[1]首都医科大学附属北京妇产医院麻醉科,100026

出　　处：《中国医药》2020年第2期292-296,共5页China Medicine

基　　金：北京市卫生和计划生育委员会卫生与健康科技成果和适宜技术推广项目(2018-TG-21)。

摘　　要：目的观察小剂量低浓度罗哌卡因在妊娠期高血压产妇分娩镇痛中的应用效果。方法选取2015年8月至2018年8月在首都医科大学附属北京妇产医院住院分娩的妊娠期高血压疾病产妇136例,按照随机数字表法分为S组和E组,每组68例。S组产妇采用低剂量0.1%罗哌卡因+舒芬太尼蛛网膜下腔-硬膜外联合镇痛;E组产妇采用低剂量0.1%罗哌卡因+舒芬太尼硬膜外镇痛。分析2组镇痛前后疼痛视觉模拟量表(VAS)评分、镇痛起效时间、运动神经阻滞评分、产程时间和分娩方式、产妇生命体征和胎心率、产妇不良事件、新生儿Apgar评分以及脐动脉血气等指标。结果S组疼痛完全缓解时间明显短于E组[(3.7±1.4)min比(11.2±4.6)min],第一产程平均VAS评分明显低于E组[(0.9±0.3)分比(1.8±0.6)分],差异均有统计学意义(均P<0.01);S组平均运动神经阻滞评分稍高于E组[(0.90±0.04)分比(0.80±0.03)分],但差异无统计学意义(P>0.05)。2组产妇第一产程时间、第二产程时间、使用缩宫素比例、分娩中降压治疗比例、器械助产及剖宫产比例比较,差异均无统计学意义(均P>0.05)。镇痛前2组平均动脉压和心率差异无统计学意义(P>0.05);镇痛后5 min时及宫颈完全扩张后S组平均动脉压和心率均明显低于E组[(86±7)mm Hg(1 mm Hg=0.133 k Pa)比(104±9)mm Hg、(86±8)mm Hg比(94±9)mm Hg,(80±8)次/min比(90±8)次/min、(80±6)次/min比(87±8)次/min],差异均有统计学意义(均P<0.01);2组镇痛后15、30、60 min时的平均动脉压和心率均明显低于镇痛前,差异均有统计学意义(均P<0.05)。2组胎心率各时间点比较差异均无统计学意义(均P>0.05)。2组产妇主要不良反应及并发症发生率、新生儿体质量、1 min Apgar评分、脐动脉血气指标比较,差异均无统计学差异(均P>0.05)。结论小剂量低浓度罗哌卡因蛛网膜下腔-硬膜外联合镇痛具有起效快、运动阻滞轻等特点,可安全有效地应用�Objective To observe the clinical efficacy of low dose and low concentration of ropivacaine for labor analgesia in parturients with pregnancy-induced hypertension.Methods From August 2015 to August 2018,136 parturients with pregnancy-induced hypertension waiting for delivery in Beijing Obstetrics and Gynecology Hospital,Capital Medical University were randomly divided into group S and group E,with 68 cases in each group.Group S had low dose 0.1%ropivacaine+sulfentanyl subarachnoid analgesia combined with epidural analgesia.Group E had low dose 0.1%ropivacaine+sulfentanyl epidural analgesia.Intensity of pain assessed by Visual Analogue Scale(VAS),onset time of analgesia,motor nerve block,labor duration and method,vital signs of parturients and fetal heart rate,adverse maternal events,neonatal Apgar score and umbilical cord blood gas indicators were analyzed.Results Pain relief time in group S was significantly shorter and VAS score during the first stage of labor was significantly lower than those in group E[(3.7±1.4)min vs(11.2±4.6)min,(0.9±0.3)vs(1.8±0.6)](both P<0.01).Motor nerve block score in group S was higher than that in group E[(0.90±0.04)vs(0.80±0.03)]but the difference was not statistically significant(P>0.05).There were no significant differences in labor duration,use of oxytocin,antihypertensive treatment during delivery,device-assistant delivery and uterine-incision delivery between groups(all P>0.05).There were no significant differences in mean arterial pressure and heart rate between groups before analgesia(P>0.05).At 5 min after analgesia and after complete dilatation of cervix,mean arterial pressure and heart rate in group S were significantly lower than those in group E[(86±7)mm Hg vs(104±9)mm Hg,(86±8)mm Hg vs(94±9)mm Hg;(80±8)times/min vs(90±8)times/min,(80±6)times/min vs(87±8)times/min](all P<0.01).At 15,30 and 60 min after analgesia,mean arterial pressure and heart rate were significantly lower than those before analgesia in both groups(all P<0.05).There were no significant di

关 键 词：妊娠期高血压 分娩镇痛 罗哌卡因 低浓度 产程 不良反应 

分 类 号：R714.24[医药卫生—妇产科学]