不同浓度盐酸罗哌卡因联合舒芬太尼硬膜外麻醉在镇痛分娩中的应用效果及对疼痛程度和产后并发症的影响  

Application effect of different concentrations of ropivacaine hydrochloride combined with sufentanil epidural anesthesia in analgesic delivery and its impact on pain severity and postpartum complications

作　　者：王爱梅 Wang Aimei(Department of Anesthesiology,Hongdong County People′s Hospital,Linfen,Shanxi 041600,China)

机构地区：[1]洪洞县人民医院麻醉科,山西临汾041600

出　　处：《中国药物与临床》2024年第23期1549-1554,共6页Chinese Remedies & Clinics

摘　　要：目的探讨不同浓度盐酸罗哌卡因联合舒芬太尼硬膜外麻醉在镇痛分娩中的应用效果及对疼痛程度、产后并发症的影响。方法研究为前瞻性研究,选取山西省洪洞县人民医院2021年3月至2024年3月收治的120例阴道分娩产妇,依据随机数字表法分为A、B、C、D 4组,各30例。所有产妇均采取盐酸罗哌卡因联合舒芬太尼硬膜外麻醉,A组盐酸罗哌卡因浓度为0.15%,B组为0.125%,C组为0.1%,D组为0.075%,4组产妇舒芬太尼浓度均为0.5μg/ml。对比4组产妇舒张压、收缩压及心率水平变化、疼痛程度、产程时间、应激激素变化及并发症发生率。结果镇痛后5 min、镇痛后10 min、宫口全开时A组舒张压[(79±4)mmHg、(75±8)mmHg、(80±5)mmHg]、收缩压[(116±10)mmHg、(114±6)mmHg、(117±6)mmHg]、心率[(83±8)次/min、(79±5)次/min、(81±5)次/min],B组舒张压[(81±7)mmHg、(76±6)mmHg、(81±6)mmHg]、收缩压[(119±10)mmHg、(115±6)mmHg、(118±7)mmHg]、心率[(84±5)次/min、(80±4)次/min、(80±4)次/min]均低于C组、D组(P<0.05),但A组与B组相比差异无统计学意义(P>0.05);A组镇痛后5 min、镇痛后10 min、宫口全开即刻视觉模拟量表(VAS)评分[(5.80±0.42)分、(3.15±0.25)分、(4.21±0.35)分]、B组[(5.88±0.24)分、(3.17±0.34)分、(4.38±0.28)分]均低于C组、D组(P<0.05),但A组与B组相比差异无统计学意义(P>0.05);A组第一产程、第二产程[(627.7±86.2)min、(55.4±4.5)min]高于B组、C组与D组(P<0.05),但B组与C组相比差异无统计学意义(P>0.05);A组宫口全开、胎儿娩出时肾上腺素(ADR)[(71±9)pg/ml、(62±4)pg/ml]、去甲肾上腺素(NE)[(452±39)pg/ml、(454±36)pg/ml]、皮质醇(COR)[(90±5)ng/ml、(92±8)ng/ml],B组宫口全开、胎儿娩出时ADR[(73±6)pg/ml、(64±6)pg/ml]、NE[(456±38)pg/ml、(456±32)pg/ml]、COR[(90±8)ng/ml、(92±10)ng/ml]均低于C组、D组(P<0.05),但A组与B组相比差异无统计学意义(P>0.05);A组并发症发生率39.9%高于B组13.3%、C组13.3%、DObjective To explore the application effect of different concentrations of ropivacaine hy-drochloride combined with sufentanil epidural anesthesia in analgesic delivery and its impact on pain severity and postpartum complications.Methods The study was a prospective study.A total of 120 women with vaginal deliv-ery admitted to Hongdong County People′s Hospital from March 2021 to March 2024 were selected and divided into 4 groups:A,B,C,and D,with 30 cases in each group.All parturients were treated with ropivacaine hy-drochloride combined with sufentanil epidural anesthesia.The concentration of ropivacaine hydrochloride in Group A was 0.15%,Group B was 0.1%,Group C was 0.075%,and Group D was 0.05%.The concentration of sufentanil in all four groups of parturients was 0.5μg/ml.The changes in diastolic blood pressure,systolic blood pressure,heart rate levels,pain severity,labor duration,stress hormone changes,and incidence of complications were compared among four groups of parturients. Results After 5 minutes of analgesia, 10 minutes after analgesia, and immediately after full opening of the cervix, the diastolic blood pressure [(79±4) mmHg, (75±8) mmHg, (80±5) mmHg], systolic blood pressure [(116±10) mmHg, (114±6) mmHg, (117±6) mmHg], and heart rate [(83±8) beats/min, (79±5) beats/min, (81±5) beats/min] in Group A, as well as the diastolic blood pressure [(81±7) mmHg, (76±6) mmHg, (81±6) mmHg], systolic blood pressure [(119±10) mmHg, (115±6) mmHg, (118±7) mmHg], and heart rate [(84±5) beats/min, (80±4) beats/min, (80±4) beats/min] in Group B, were all lower than those in Group C and Group D (P<0.05). However, there was no statistically significant difference between Group A and Group B (P>0.05). The visual analog scale (VAS) scores [(5.80±0.42) points, (3.15±0.25) points, (4.21±0.35) points] and Group B [(5.88±0.24) points, (3.17±0.34) points, (4.38±0.28) points] were all lower than those of Group C and Group D (P<0.05) after 5 minutes of analgesia, 10 minutes after analgesia, and immediate

关 键 词：盐酸罗哌卡因 舒芬太尼 麻醉 硬膜外 镇痛 应激反应 分娩并发症 

分 类 号：R714.3[医药卫生—妇产科学]