浓度递增法程控硬膜外间歇脉冲注入罗哌卡因在妊娠期高血压产妇分娩中的应用  

Application of dose-escalation method for programmed intermittent epidural bolus of ropivacaine in delivery of pregnant women with gestational hypertension

作　　者：黄阳 叶斌 黄涛[2] Huang Yang;Ye Bin;Huang Tao(Department of Anesthesiology,Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University,Yangzhou 225001,China;Department of Obstetrical,Yangzhou Maternal and Child Health Care Hospital Affiliated to Yangzhou University,Yangzhou 225001,China)

机构地区：[1]扬州大学医学院附属扬州妇幼保健院麻醉科,扬州225001 [2]扬州大学医学院附属扬州妇幼保健院产科,扬州225001

出　　处：《国际麻醉学与复苏杂志》2024年第7期720-725,共6页International Journal of Anesthesiology and Resuscitation

摘　　要：目的探讨浓度递增法程控硬膜外间歇脉冲注入罗哌卡因在妊娠期高血压产妇分娩中的应用价值。方法选取妊娠期高血压疾病(HDCP)待产产妇136例,按随机数字表法分为对照组和观察组(每组68例)。两组均行硬膜外穿刺置管,分娩过程中对照组采用固定浓度法给药,观察组根据产程进展采用浓度递增法给药。记录产妇一般资料,镇痛起效时间,镇痛显效时间,镇痛时间,产程时间(第一产程、第二产程、第三产程),镇痛前、镇痛后5 min、镇痛后10 min及各产程收缩压和舒张压;检测麻醉前(T_(0))、分娩时(T_(1))、胎儿出生时(T_(2))、胎盘娩出5 min(T_(3))、胎盘娩出1 h(T_(4))、胎盘娩出6 h(T_(5))时血浆皮质醇浓度和肾上腺素浓度;评估镇痛前(t_(0))、镇痛后10 min(t_(1))、镇痛后30 min(t_(2))、镇痛后1 h(t_(3))、镇痛后2 h(t_(4))、宫口开全时(t_(5))、分娩时(t_(6))的视觉模拟评分法(VAS)疼痛评分;记录产妇分娩结束后24 h镇痛满意度和不良反应发生情况。采用广义估计方程(GEE)法评估固定浓度法和浓度递增法对总产程时间、收缩压和舒张压的影响。结果与对照组比较,观察组产妇在镇痛后5 min、镇痛后10 min收缩压和舒张压较低(均P<0.05),第二产程、第三产程及镇痛显效时间较短,镇痛时间较长(均P<0.05);两组一般资料,镇痛前、第一产程、第二产程和第三产程的收缩压和舒张压,第一产程和镇痛起效时间等差异均无统计学意义(均P>0.05)。T_(1)~T_(5)时对照组血浆皮质醇浓度和肾上腺素浓度高于观察组(均P<0.05);与T_(0)时比较,T_(1)~T_(5)时对照组血浆皮质醇浓度和肾上腺素浓度升高(均P<0.05),T_(2)时观察组肾上腺素浓度升高(P<0.05)。t_(4)~t_(6)时对照组产妇VAS疼痛评分明显高于观察组(均P<0.05);与t_(0)时比较,t_(1)~t_(6)时两组产妇VAS疼痛评分明显降低(均P<0.05)。多因素校正后结果显示,对照组与总产程时间、舒张压Objective To evaluate the application of dose-escalation method for programmed intermittent epidural bolus of ropivacaine in delivery of pregnant women with gestational hypertension.Methods A total of 136 women with hypertensive disorder complicating pregnancy(HDCP)in labor were selected as subjects.According to the random number table method,they were divided into two groups:a control group and an observation group(n=68).Both groups underwent epidural puncture and catheterization.The control group was administered with a fixed concentration of anesthetic agents during labor(the fixed dose method),while in the observation group,the dose of anesthetic agents gradually increased according to the progress of labor(the dose-escalation method).Both groups were compared for general information,time to analgesia onset,analgesic effective time,duration of analgesia,duration of labor(the first stage of labor,the second stage of labor,and the third stage of labor),changes in systolic blood pressure and diastolic blood pressure before analgesia,5 min after analgesia,and 10 min after analgesia.Plasma cortisol and epinephrine concentrations were measured before anesthesia(T_(0)),at the time of delivery(T_(1)),at the time of fetal birth(T_(2)),5 min after delivery of the placenta(T_(3)),1 h after delivery of the placenta(T_(4)),and 6 h after delivery of the placenta(T_(5)).Their Visual Analog Scale(VAS)scores were compared before anesthesia(t_(0)),10 min after anesthesia(t_(1)),30 min after anesthesia(t_(2)),1 h after anesthesia(t_(3)),2 h after anesthesia(t_(4)),at the opening of the uterine orifice(t_(5)),and at delivery(t_(6)).The satisfaction with analgesia and the incidences of adverse reactions 24 h after labor were recorded in both groups.The generalized estimating equation(GEE)method was used to assess the effect of fixed-dose and dose-escalation-methods on the total duration of labor and blood pressure.Results Compared with the control group,the observation group showed significant decreases in systolic and diastolic

关 键 词：妊娠期高血压疾病 硬膜外分娩镇痛 脉冲注入 浓度递增法 罗哌卡因 舒芬太尼 

分 类 号：R614[医药卫生—麻醉学]