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％、D组6.7％(P<0.05),但B、C、D 3组对比差异无统计学意义(P>0.05).结论 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差异具有统计学意义,其中盐酸罗哌卡因浓度为0.15％和0.125％可改善产妇术中血压、心率波动,提升镇痛效果,减轻产妇应激反应,但0.15％盐酸罗哌卡因可增加产妇产程时间与并发症情况.
Abstract
Objective 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 0.5 μg/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 com-pared 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 immediately after full opening of the cervix.However,there was no difference between Group A and Group B (P>0.05).The first and second stages of labor in Group A[(627.7±86.2) min,(55.4±4.5) min]were higher than those in Group B,Group C and Group D,but there was no difference between Group B and Group C (P>0.05).Group A:Adrenaline (ADR)[(71±9) pg/ml,(62±4) pg/ml],norepinephrine (NE)[(452±39) pg/ml,(454±36) pg/ml],cortisol (COR)[(90±5) ng/ml,(92±8) ng/ml]during full opening of the cervix and fetal delivery;Group B:ADR[(73±6) pg/ml]during full opening of the cervix and fetal delivery L,(64±6) pg/ml],NE[(456±38) pg/ml,(456±32) pg/ml],COR[(90±8) ng/ml,(92±10) ng/ml]were all lower than those of Group C and Group D (P<0.05),but there was no difference between Group A and Group B (P>0.05).The incidence of complications in Group A was 40.00％ higher than that in Group B (13.3％),Group C (13.3％),and Group D (6.7％) (P<0.05),but there was no difference among the three groups B,C,and D.Conclu-sion There are significant differences in the application effect of different concentrations of ropivacaine hy-drochloride combined with sufentanil epidural anesthesia in analgesic delivery.Among them,ropivacaine hy-drochloride concentrations of 0.15％ and 0.1％ can improve intraoperative blood pressure and heart rate fluctua-tions,enhance analgesic effect,shorten labor process time,and reduce maternal stress reactions.However,0.15％ropivacaine hydrochloride may increase maternal complications.
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