| 王 雪,傅玉纯,冯丽娥,刘朝晖,谭 刚.不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛应用于无痛分娩的效果观察[J].,2022,(1):57-62 |
| 不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛应用于无痛分娩的效果观察 |
| Effect Observation of Different Dose of Ropivacaine Combined with Dezocine Patient-Controlled Epidural Analgesia in the Application for Painless Labor |
| 投稿时间：2021-07-23 修订日期：2021-08-18 |
| DOI：10.13241/j.cnki.pmb.2022.01.009 |
| 中文关键词: 硬膜外自控镇痛 罗哌卡因 地佐辛 分娩镇痛 |
| 英文关键词: Patient-controlled epidural analgesia Ropivacaine Dezocine Labor analgesia |
| 基金项目:北京市科委基金资助项目（D12110700420000） |
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| 中文摘要: |
| 摘要 目的：探讨不同剂量罗哌卡因复合地佐辛硬膜外自控镇痛（PCEA）应用于无痛分娩的临床价值。方法：选择2019年1月~12月于北京协和医院拟行自然分娩的初产妇180例，按随机数余数法分为A、B、C三组，每组60例，分别采用0.75%罗哌卡因0.33 mL（2.50 mg）、0.50 mL（3.75 mg）、0.67 mL（5.0 mg）复合地佐辛PCEA分娩镇痛，宫口开至2~3 cm时进行无痛分娩，L2~L3间隙穿刺，头侧置管行PCEA，宫口开全时停止PCEA。比较三组镇痛前（T0）、镇痛15 min（T1）、宫口全开（T2）、胎儿娩出（T3）、胎盘娩出（T4）及缝合会阴（T5）视觉模拟评分（VAS），采用改良Bromage评分评估下肢运动神经阻滞效果，统计各组镇痛起效时间、镇痛开始至宫口全开时间、第一产程、第二产程和第三产程时间，统计各组达目标麻醉平面时镇痛药物用量及产妇镇痛泵按压次数，记录各组产后出血量及最终分娩方式，采用新生儿阿氏评分法（Apgar）评定新生儿窒息情况，并行脐血血气分析，统计各组分娩期间不良反应发生情况。结果：T1~T5时点三组VAS评分均较T0时点降低（P<0.05），B、C组T1~T5时点VAS评分均低于A组（P<0.05）；三组改良Bromage分级分布比较差异有统计学意义（P<0.05）；B、C组镇痛起效时间较A组更快，第二产程时间、第三产程时间较A组缩短，达目标麻醉平面镇痛药物用量、镇痛泵按压次数、有效按压次数均较A组减少（P<0.05），B、C组以上指标对比差异无统计学意义（P>0.05）；三组产后出血量、最终分娩方式、新生儿出生1 min、5 min Apgar评分、pH值、血氧分压（PO2）、二氧化碳分压（PCO2）和不良反应发生率比较差异无统计学意义（P>0.05）。结论：0.75%罗哌卡因0.50 mL（3.75 mg）复合地佐辛PCEA分娩镇痛在无痛分娩中镇痛效果满意，对产程、宫缩、母婴影响小，具有运动神经阻滞、感觉神经阻滞分离优势，不良反应少，安全性高。 |
| 英文摘要: |
| ABSTRACT Objective: To explore the value of different doses of ropivacaine combined with dezocine in patient-controlled epidural analgesia (PCEA) in the application for painless labor. Methods: 180 primiparas who planned to give birth naturally in Peking Union Medical College Hospital from January to December in 2019 were selected. According to the method of random remainder, they were divided into group A, B and C, with 60 cases in each group. 0.75% ropivacaine 0.33 mL (2.50 mg), 0.50 mL (3.75 mg), 0.67 mL (5.0 mg) combined with dezocine PCEA for labor analgesia were used respectively. Painless labor was performed when the uterine orifice was opened to 2~3 cm, L2~L3 interstitial puncture, a cephalic tube was placed on the PCEA, PCEA was stopped at the full time of uterine opening. The visual analogue scale (VAS) scores before analgesia (T0), analgesia 15 minutes (T1), full opening (T2), fetal delivery (T3), placental delivery (T4) and sutures Perineum (T5) were compared in the three groups. The modified Bromage score was used to evaluate the effect of lower extremity motor nerve block. The analgesic onset time, the time from the beginning of analgesia to the full opening of the uterine orifice, the first stage of labor, the second stage of labor, and the third stage of labor were counted, and the amount of analgesic drugs used when each group reached the target anesthesia level and the times of pressing the analgesic pump were counted. The amount of postpartum hemorrhage and final delivery methods in each group were recorded, and the neonatal Apgar score method (Apgar) was used to evaluate the neonatal asphyxia, cord blood gas analysis was performed, and the incidence of adverse reactions during delivery of each group was counted. Results: VAS scores of the three groups at T1~T5 time points decreased compared with those of T0 time points (P<0.05), and VAS scores at T1~T5 time points in groups B and C were all lower than those in group A (P<0.05). There was statistical significance in the modified Bromage grading distribution among the three groups (P<0.05). The onset time of analgesia in group B, C was faster than that in group A， and the time of the second stage of labor and the third stage of labor in group B, C was shorter than that in group A, the amount of analgesic drugs used when each group reached the target anesthesia level, the times of pressing the analgesic pump and the times of effective pressing were all reduced compared with those of group A (P<0.05), and there were no statistically significant difference in the above indicators between group B and group C (P>0.05). There were no statistically significant differences in the amount of postpartum hemorrhage, final delivery methods, Apgar scores at 1min and 5min after birth, pH value, blood oxygen partial pressure (PO2), carbon dioxide partial pressure (PCO2) and the incidence rate of adverse reactions in the three groups (P>0.05). Conclusion: 0.75% ropivacaine 0.50 mL (3.75 mg) combined with dezocine PCEA has satisfactory analgesic effect in painless labor, little effect on labor process, uterine contraction, mother and child, has the advantages of separation of motor nerve block and sensory nerve block, with less adverse reactions and has a high safety. |
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