罗哌卡因联合舒芬太尼在无痛分娩中的应用效果
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摘要
目的研究罗哌卡因联合舒芬太尼在无痛分娩中的应用效果。方法选取2016年6月～2018年6月在中南大学湘雅二医院和湖南省妇幼保健院分娩的160例产妇,采用随机数字表法将其分为罗哌卡因组和联合用药组,每组各80例。罗哌卡因组使用罗哌卡因进行镇痛,联合用药组使用舒芬太尼和罗哌卡因混合液进行镇痛。比较两组产妇镇痛效果;检测垂体泌乳素(PRL)水平,比较两组产妇泌乳量;比较两组新生儿血气及Apgar评分。结果联合用药组产妇用药后镇痛起效时间和完全阻滞时间短于罗哌卡因组,持续时间长于罗哌卡因组,差异有统计学意义(P <0.05);联合用药组泌乳开始时间短于罗哌卡因组,且泌乳量及产后24 h、48 h的PRL浓度高于罗哌卡因组,差异有统计学意义(P <0.05);联合用药组胎儿血pH、动脉血氧分压(PaO2)水平及新生儿Apgar评分高于罗哌卡因组,动脉血二氧化碳分压(PaCO2)水平低于罗哌卡因组,差异有统计学意义(P <0.05);联合用药组产妇用药后疼痛缓解情况及乳房胀痛缓解情况均优于罗哌卡因组(P <0.05);联合用药组总满意度高于罗哌卡因组,总不良反应率低于罗哌卡因组,差异有统计学意义(P <0.05)。结论罗哌卡因联合舒芬太尼在无痛分娩中的效果更好,用药更安全。
Objective To study the application effects of Ropivacaine combined with Sufentanil on painless childbirth.Methods From June 2016 to June 2018, 160 parturients delivered in the Second Xiangya Hospital of Central South University and Hu'nan Provincial Maternity and Child Health Care Hospital were selected, and they were divided into the Ropivacaine group and the combination group by random number table method, with 80 cases in each group. Ropivacaine group was treated by Ropivacaine for analgesia, and the combination group was treated by Sufentanil and Ropivacaine for analgesia. The analgesic effects of the two groups were compared. Prolactin(PRL) level was detected and lactation volume was compared between the two groups. Blood gas and Apgar scores of neonates were compared between the two groups. Results The analgesic effect time and complete block time of the combination group were shorter than those of Ropivacaine group, and the duration was longer than that of Ropivacaine group, the differences were statistically significant(P < 0.05). The lactation initiation time of the combination group was shorter than that of Ropivacaine group, and the lactation volume and concentrations of PRL at postpartum 24 h and 48 h were higher than those of Ropivacaine group, the differences were statistically significant(P < 0.05). The blood pH, artery blood oxygen partial pressure(PaO2) level of the fetus and Apgar score of neonates in the combination group were higher than those of Ropivacaine group, and artery blood partial pressure of carbon dioxide(PaCO2) level was lower than that of Ropivacaine group, the differences were statistically significant(P < 0.05). The pain relief and breast distending pain relief in combination group were better than those in Ropivacaine group(P < 0.05); the overall satisfaction of the combination group was higher than that of Ropivacaine group, and the total adverse reaction rate was lower than that of Ropivacaine group,the differences were statistically significant(P < 0.05). Conclusion Ropivacaine combined with Sufentanil is more effective and safe for painless labor.
Objective To study the application effects of Ropivacaine combined with Sufentanil on painless childbirth.Methods From June 2016 to June 2018, 160 parturients delivered in the Second Xiangya Hospital of Central South University and Hu'nan Provincial Maternity and Child Health Care Hospital were selected, and they were divided into the Ropivacaine group and the combination group by random number table method, with 80 cases in each group. Ropivacaine group was treated by Ropivacaine for analgesia, and the combination group was treated by Sufentanil and Ropivacaine for analgesia. The analgesic effects of the two groups were compared. Prolactin(PRL) level was detected and lactation volume was compared between the two groups. Blood gas and Apgar scores of neonates were compared between the two groups. Results The analgesic effect time and complete block time of the combination group were shorter than those of Ropivacaine group, and the duration was longer than that of Ropivacaine group, the differences were statistically significant(P < 0.05). The lactation initiation time of the combination group was shorter than that of Ropivacaine group, and the lactation volume and concentrations of PRL at postpartum 24 h and 48 h were higher than those of Ropivacaine group, the differences were statistically significant(P < 0.05). The blood pH, artery blood oxygen partial pressure(PaO2) level of the fetus and Apgar score of neonates in the combination group were higher than those of Ropivacaine group, and artery blood partial pressure of carbon dioxide(PaCO2) level was lower than that of Ropivacaine group, the differences were statistically significant(P < 0.05). The pain relief and breast distending pain relief in combination group were better than those in Ropivacaine group(P < 0.05); the overall satisfaction of the combination group was higher than that of Ropivacaine group, and the total adverse reaction rate was lower than that of Ropivacaine group,the differences were statistically significant(P < 0.05). Conclusion Ropivacaine combined with Sufentanil is more effective and safe for painless labor.
引文
[1]江絮萍,叶泓.连续硬膜外麻醉在无痛分娩中的应用观察[J].山东医药,2013,53(8):76-77.
[2]孙立萍.无痛分娩技术在产科临床的应用效果观察[J].临床合理用药杂志,2013,6(19):138-139.
[3]邹金才.顺产产妇脐带血中抗氧化剂水平与分娩疼痛的相关性[J].贵阳医学院学报,2014,39(2):221-224.
[4]李晓英.关于优质护理运用在妊高症产妇产后出血护理中对其产后出血VAS评分的影响分析[J].中国保健营养,2016,26(17):337.
[5]史玮青,范向凯,王晓红,等.罗哌卡因复合芬太尼或苏芬太尼在分娩镇痛中的疗效比较[J].中国基层医药,2016,23(4):564-567.
[6]贺晶,闫雪.腰硬联合麻醉与硬膜外麻醉对重度子痫前期剖宫产产妇血流动力学和新生儿apgar评分的影响[J].中国实验诊断学,2016,20(10):1709-1712.
[7]杨湘妹,邱嵘,刘茜,等.助产士主导分娩疼痛管理对分娩结局及疼痛控制满意度的影响[J].重庆医学,2017,46(10):1333-1335. doi:10.3969/j.issn.1671-8348.2017.10.011.
[8]曾慧琳,詹伦娟.无痛分娩用于临床初产妇的效果及对母婴结局的影响[J].中国药物经济学,2015,10(6):104-106.
[9]蔚杰慧,赵学英.242例无痛分娩对产程的影响分析[J].中国病案,2017,18(11):110-112. doi:10.3969/j.issn.1672-2566.2017.11.038.
[10]樊薇,杨琳,史玉琴,等.罗哌卡因、舒芬太尼联合穴位针刺在无痛分娩中的应用效果[J].西部中医药,2018,31(1):98-101. doi:10.3969/j.issn.1004-6852.2018.01.029.
[11]周金彩,吴春秀,张乐,等.小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于无痛分娩对母婴结局的影响[J].临床合理用药杂志,2016,9(4):43-45. doi:10.15887/j.cnki.13-1389/r.2016.04.026.
[12]徐晓义,褚国强,季永,等.腰-硬联合阻滞腰麻后硬膜外镇痛时机对分娩镇痛的影响[J].临床麻醉学杂志,2015,31(2):154-157.
[13]王大伟,王保国,刘长宝,等.不同剂量罗哌卡因复合舒芬太尼腰-硬联合阻滞在产程潜伏期分娩镇痛的效果[J].临床麻醉学杂志,2015,31(6):538-542.
[14]李晓虎.罗哌卡因、舒芬太尼单独或联合用药连续蛛网膜下隙阻滞用于分娩镇痛效果的比较[J].中国生化药物杂志,2017,37(6):271-272,275. doi:10.3969/j.issn.1005-1678.2017.06.101.
[15]余怡冰,林蓉,徐振东,等.瑞芬太尼静脉自控分娩镇痛与舒芬太尼联合罗哌卡因硬膜外自控分娩镇痛效果的同期对照研究[J].中华妇幼临床医学杂志:电子版,2016,12(3):326-333. doi:10.3877/cma.j.issn.1673-5250.2016.03.014.
[16]呼松月.罗哌卡因联合舒芬太尼用于分娩镇痛效果的临床观察[J].中国计划生育学杂志,2015,23(4):252-254.
[17]陈祥楠,杨世辉,林辉瑞,等.穴位注射罗哌卡因的分娩镇痛效果及其对产妇皮质醇水平的影响[J].南方医科大学学报,2018,38(4):502-504. doi:10.3969/j.issn.1673-4254.2018.04.22.
[18]王晓光,李戈辉,齐晓非,等.不同质量浓度舒芬太尼复合罗哌卡因在分娩孕妇镇痛效果的比较[J].浙江临床医学,2016,18(7):1346-1347.
[19]张荣.罗哌卡因复合舒芬太尼在分娩镇痛中的应用[J].河北医科大学学报,2016,37(3):337-339. doi:10.3969/j.issn.1007-3205.2016.03.025.
[20]朱全忙.罗哌卡因复合舒芬太尼连续硬膜外镇痛用于无痛分娩的效果[J].中华全科医学,2015,13(9):1550-1551.
[2]孙立萍.无痛分娩技术在产科临床的应用效果观察[J].临床合理用药杂志,2013,6(19):138-139.
[3]邹金才.顺产产妇脐带血中抗氧化剂水平与分娩疼痛的相关性[J].贵阳医学院学报,2014,39(2):221-224.
[4]李晓英.关于优质护理运用在妊高症产妇产后出血护理中对其产后出血VAS评分的影响分析[J].中国保健营养,2016,26(17):337.
[5]史玮青,范向凯,王晓红,等.罗哌卡因复合芬太尼或苏芬太尼在分娩镇痛中的疗效比较[J].中国基层医药,2016,23(4):564-567.
[6]贺晶,闫雪.腰硬联合麻醉与硬膜外麻醉对重度子痫前期剖宫产产妇血流动力学和新生儿apgar评分的影响[J].中国实验诊断学,2016,20(10):1709-1712.
[7]杨湘妹,邱嵘,刘茜,等.助产士主导分娩疼痛管理对分娩结局及疼痛控制满意度的影响[J].重庆医学,2017,46(10):1333-1335. doi:10.3969/j.issn.1671-8348.2017.10.011.
[8]曾慧琳,詹伦娟.无痛分娩用于临床初产妇的效果及对母婴结局的影响[J].中国药物经济学,2015,10(6):104-106.
[9]蔚杰慧,赵学英.242例无痛分娩对产程的影响分析[J].中国病案,2017,18(11):110-112. doi:10.3969/j.issn.1672-2566.2017.11.038.
[10]樊薇,杨琳,史玉琴,等.罗哌卡因、舒芬太尼联合穴位针刺在无痛分娩中的应用效果[J].西部中医药,2018,31(1):98-101. doi:10.3969/j.issn.1004-6852.2018.01.029.
[11]周金彩,吴春秀,张乐,等.小剂量罗哌卡因复合舒芬太尼腰硬联合麻醉用于无痛分娩对母婴结局的影响[J].临床合理用药杂志,2016,9(4):43-45. doi:10.15887/j.cnki.13-1389/r.2016.04.026.
[12]徐晓义,褚国强,季永,等.腰-硬联合阻滞腰麻后硬膜外镇痛时机对分娩镇痛的影响[J].临床麻醉学杂志,2015,31(2):154-157.
[13]王大伟,王保国,刘长宝,等.不同剂量罗哌卡因复合舒芬太尼腰-硬联合阻滞在产程潜伏期分娩镇痛的效果[J].临床麻醉学杂志,2015,31(6):538-542.
[14]李晓虎.罗哌卡因、舒芬太尼单独或联合用药连续蛛网膜下隙阻滞用于分娩镇痛效果的比较[J].中国生化药物杂志,2017,37(6):271-272,275. doi:10.3969/j.issn.1005-1678.2017.06.101.
[15]余怡冰,林蓉,徐振东,等.瑞芬太尼静脉自控分娩镇痛与舒芬太尼联合罗哌卡因硬膜外自控分娩镇痛效果的同期对照研究[J].中华妇幼临床医学杂志:电子版,2016,12(3):326-333. doi:10.3877/cma.j.issn.1673-5250.2016.03.014.
[16]呼松月.罗哌卡因联合舒芬太尼用于分娩镇痛效果的临床观察[J].中国计划生育学杂志,2015,23(4):252-254.
[17]陈祥楠,杨世辉,林辉瑞,等.穴位注射罗哌卡因的分娩镇痛效果及其对产妇皮质醇水平的影响[J].南方医科大学学报,2018,38(4):502-504. doi:10.3969/j.issn.1673-4254.2018.04.22.
[18]王晓光,李戈辉,齐晓非,等.不同质量浓度舒芬太尼复合罗哌卡因在分娩孕妇镇痛效果的比较[J].浙江临床医学,2016,18(7):1346-1347.
[19]张荣.罗哌卡因复合舒芬太尼在分娩镇痛中的应用[J].河北医科大学学报,2016,37(3):337-339. doi:10.3969/j.issn.1007-3205.2016.03.025.
[20]朱全忙.罗哌卡因复合舒芬太尼连续硬膜外镇痛用于无痛分娩的效果[J].中华全科医学,2015,13(9):1550-1551.