罗哌卡因+氢吗啡酮用于腰硬联合阻滞麻醉分娩镇痛的效果研究  

Study on labor analgesic effect of ropivacaine plus hydromorphone in combined lumbar-epidural block anesthesia

作　　者：吴冠男 崔蕾[1] WU Guannan;CUI Lei(Department of Anesthesiology,Xuzhou Municipal Central Hospital,Xuzhou,Jiangsu 221000,China)

机构地区：[1]徐州市中心医院麻醉科,江苏徐州221000

出　　处：《重庆医学》2023年第14期2164-2169,共6页Chongqing medicine

基　　金：2020年高层次卫生人才“六个一工程”拔尖人才项目(LGY2020009)。

摘　　要：目的探讨罗哌卡因+氢吗啡酮用于腰硬联合阻滞麻醉分娩镇痛的效果。方法选取2019年4月至2020年4月该院接收的足月妊娠单胎头位孕产妇260例,以随机数表法分为研究组和对照组,每组130例。对照组予以单纯罗哌卡因腰硬联合阻滞麻醉处理,研究组予以罗哌卡因+氢吗啡酮腰硬联合阻滞麻醉处理。比较两组孕产妇产程持续时间、产后出血量、生命体征、镇痛效果、新生儿的阿普加评分(Apgar评分)、改良双下肢运动阻滞程度评分(Bromange评分)、镇静评分、呼吸抑制和恶心呕吐的发生情况。结果研究组孕产妇麻醉起效后10 min、15 min、30 min、60 min及宫口全开时视觉模拟评分量表(VAS)评分随时间推移明显降低,且明显低于对照组(P<0.05)。两组孕产妇第1、2、3产程持续时间,产后出血量比较差异无统计学意义(P>0.05)。两组孕产妇在麻醉前至胎儿娩出的过程中,血氧饱和度(SpO2)、血压、心率(HR)在组间和组内比较差异均无统计学意义(P>0.05)。研究组孕产妇Bromange评分整体情况明显优于对照组(P<0.05),两组新生儿娩出后1 min和5 min时Apgar评分、镇静评分、呼吸抑制率和恶心呕吐发生率比较差异无统计学意义(P>0.05)。结论罗哌卡因+氢吗啡酮腰硬联合阻滞麻醉有良好的镇痛效果,能改善孕产妇运动阻滞状态。Objective To investigate the labor analgesic effect of ropivacaine combined with hydromorphone in combined spinal-epidural block anesthesia.Methods Two hundreds and sixty full-term pregnant women with singleton head positions in this hospital from April 2019 to April 2020 were selected and divided into the study group and control group by the random number table method,130 cases in each group.The control group was treated with ropivacaine combined spinal epidural block anesthesia alone,and the study group was given ropivacaine+hydromorphone combined spinal-epidural block anesthesia for labor analgesia.The labor process duration,postpartum hemorrhage amount,vital signs,analgesic effect,neonatal Apgar score,motor block scores of both lower extremities(Bromange score),sedation score and occurrence situation of respiratory depression and vomiting and nausea were compared between the two groups.Results The VAS scores at 10,15,30,60 min after anesthesia effect beginning in the study group were significantly decreased with the time lapse,moreover which were significantly lower than those in the control group(P<0.05).The duration of the first stage of labor,second stage of labor and third stage of labor and postpartum hemorrhage amount had no statistical difference between the two groups(P>0.05).During the period from before anesthesia to fetal delivery,SpO 2 and vital signs change between and within the groups had no statistically significant difference(P>0.05).The Bromange score overall situation in the study group was superior to the control group(P<0.05).The Apgar score at 1,5 min after neonate delivery,sedation score,respiratory suppression rate and occurrence rate of vomiting and nausea had no statistical differences between the two groups(P>0.05).Conclusion Ropivacaine+hydromorphone in combined lumbar epidural anesthesia has good analgesic effect and improves the state of motion block of pregnant women.

关 键 词：罗哌卡因 氢吗啡酮 腰硬联合阻滞麻醉 妊娠分娩 分娩镇痛 

分 类 号：R714.3[医药卫生—妇产科学]