硬膜外间断与持续给药对初产妇足月自然分娩麻醉效果  

Anesthetic effect of epidural intermittent and continuous administration of anaesthetic drugs for primipara with full term natural delivery

作　　者：程勤耘 尹学军 陈君墨 汪明珠 CHENG Qinyun;YIN Xuejun;CHEN Junmo;WANG Mingzhu(The Eighth People's Hospital of Hefei,Chaohu,Anhui Province,238000;Chaohu Hospital Affiliated to Anhui Medical University)

机构地区：[1]安徽省合肥市第八人民医院,巢湖238000 [2]安徽医科大学附属巢湖医院

出　　处：《中国计划生育学杂志》2023年第9期2068-2072,2077,共6页Chinese Journal of Family Planning

摘　　要：目的:硬膜外规律间断给药和持续给药对足月自然分娩初产妇的麻醉效果比较。方法:选取2021年1月-2022年3月本院140例足月自然分娩初产妇,根据分娩镇痛方式分为两组各70例,分别采取硬膜外持续给药(持续组)或硬膜外规律间断给药(间断组),比较两组镇痛前(T0),以及宫口开到3cm(T1)、7cm(T2)、分娩(T3)和胎儿娩出(T4)时的疼痛视觉模拟评分(VAS)、体温及白细胞介素-6(IL-6)水平,以及两组罗哌卡因和舒芬太尼用量、产程,产间发热、缩宫素应用、人工破膜和器械辅助分娩情况,下肢运动神经阻滞和不良妊娠事件发生率等。结果:两组T0时VAS、体温及IL-6水平无差异(P>0.05),T1~T4间断组VAS得分均低于持续组(P<0.05);两组T2、T3和T4时体温均高于T0时(P<0.05);间断组T1~T4时IL-6水平均低于持续组(P<0.05),产间发热率(20.0%)与持续组(24.3%)无差异(P>0.05),罗哌卡因(61.3±9.8mg)、舒芬太尼(24.5±3.4μg)用量少于持续组(72.0±10.2mg、32.0±5.3μg),第一产程(563.7±43.3min)、第二产程(48.5±9.6min)时间短于持续组(612.5±49.2min、63.2±11.4 min),器械辅助分娩率(8.6%)低于持续组(21.4%),胎窘、产后出血、子宫破裂以及产道撕裂伤不良妊娠事件总发生率(12.9%)低于持续组(2.9%)(均P<0.05)。结论:足月自然分娩初产妇应用硬膜外规律间断给药相较持续给药方式,能更好地进行分娩镇痛,减少麻醉药物用量,缩短产程,对运动神经阻滞影响更小,改善妊娠结局。Objective:To compare the anesthetic effects of regular epidural intermittent administration and continuous administration of anaesthetic drugs for primipara with full term natural deliver.Methods:140full-term natural delivery primipara were selected and were divided into two groups(70cases in each group)according to the different mode of labor analgesia from January 2021to March 2022.The primiparas in group A were given continuous epidural administration of anaesthetic drugs,and the primiparas in group B were given regular epidural intermittent administration of anaesthetic drugs.The pain score of visual analog scale(VAS),the body temperature value,and the IL-6level of the primiparas before analgesia(T0),at the time of the orifice of the uterus opened to 3cm(T1)or to 7cm(T2),at the time of delivery(T3),or at the time of delivery of the baby(T4)were compared between the two groups.The dosage of ropivacaine and sufentanil used,the labor process,the proportion of intrapartum fever,the oxytocin application,the situations of artificial membrane rupture and instrument assisted delivery,and the incidences of lower limb motor nerve block and adverse pregnancy events of the primiparas were compared between the two groups.Results:There were no significant differences in the VAS score,the body temperature value,and the IL-6level of the primiparas at T0between the two groups(P>0.05).The VAS score of the primiparas in group B at T1-T4were significantly lower than those of the primiparas in group A(P<0.05).The body temperature value of the primiparas in both groups at T2,T3,or T4was significantly higher than that at T0(P<0.05).The IL-6level of the primiparas in group B at T1-T4were significantly lower than those in group A(P<0.05),and there was no significant difference in the rate of intrapartum fever(20.0%vs.24.3%)of the primiparas between the two groups(P>0.05).The dosages of ropivacaine used(61.3±9.8mg)and sufentanil used(24.5±3.4μg)of the primiparas in group B were significantly lower than those(72.0±10.2mg and 32.0±

关 键 词：初产妇 足月产 自然分娩 硬膜外麻醉 间断给药 持续给药 麻醉效果 

分 类 号：R614[医药卫生—麻醉学]