不同硬膜外麻醉给药方案对足月初产妇围手术期的影响
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摘要
目的探究不同硬膜外麻醉给药方案对足月初产妇围手术期的影响。方法将2017年1月至2018年1月在江苏省昆山市第一人民医院妊娠分娩的40例足月初产妇作为研究对象,对其临床资料进行回顾性分析。按照给药方案将患者分为观察组和对照组,每组各20例。对照组:镇痛开始15 min后给予持续输注麻醉,10 ml/h;观察组:镇痛开始75 min后,每1 h注入10 ml,使视觉模拟评分(VAS)降至3分,分娩后1 h停止给药。比较两组产妇的产间发热、疼痛程度及麻醉药物用量情况。结果两组产妇产间发热发生率比较(25. 0%vs. 20. 0%),差异无统计学意义(P>0. 05)。两组产妇镇痛后不同时间点VAS评分均显著低于镇痛前,差异有统计学意义(P <0. 05),且观察组产妇镇痛后3 h、4 h VAS评分均明显低于对照组,差异具有统计学意义(P <0. 05)。观察组产妇罗哌卡因、舒芬太尼用药量明显少于对照组,差异有统计学意义(P <0. 05)。结论硬膜外规律间断给药麻醉,不会对产间产妇体温产生不利影响,且能够缓解产妇疼痛,减少麻醉药物用量,值得临床推广应用。
Objective To explore the effects of different epidural anesthetic regimens on fever,pain and dosage of narcotic drugs in primipara. Methods Forty puerperal parturients which were given birth in our hospital from January 2017 January 2018 were selected as the study objects,the clinical data were retrospectively analyzed,they were divided into two groups by random digital table method,20 cases in each group,The control group were given continuous infusion anesthesia after 15 min analgesia and 10 ml/h; the observation group: after the onset of analgesia,75 min,each 1 h were injected to 10 ml,and the visual analogue score( VAS) was reduced to 3 points,and 1 h after delivery was stopped,and the two groups of parturients had fever,pain degree and narcotic drugs. The amount of the dosage was evaluated synthetically. Results The difference of incidences of fever between the two groups was not significant( 25. 0% vs. 20. 0%,P > 0. 05). The VAS scores at different time points of the two groups were significantly lower than before analgesia( P < 0. 05),and the 3 and 4 h VAS scores of the observation group were lower than the control group( P < 0. 05),and the difference were statistically significant. Compared with the control group,the observation group had fewer drugs for ropivacaine and sufentanil( P < 0. 05),and the difference between the two groups was statistically significant. Conclusion The intermittent administration of epidural anesthesia will not have an adverse effect on the body temperature of the parturient,and can relieve the pain of the parturient and reduce the dosage of narcotic drugs. It is worth popularizing.
Objective To explore the effects of different epidural anesthetic regimens on fever,pain and dosage of narcotic drugs in primipara. Methods Forty puerperal parturients which were given birth in our hospital from January 2017 January 2018 were selected as the study objects,the clinical data were retrospectively analyzed,they were divided into two groups by random digital table method,20 cases in each group,The control group were given continuous infusion anesthesia after 15 min analgesia and 10 ml/h; the observation group: after the onset of analgesia,75 min,each 1 h were injected to 10 ml,and the visual analogue score( VAS) was reduced to 3 points,and 1 h after delivery was stopped,and the two groups of parturients had fever,pain degree and narcotic drugs. The amount of the dosage was evaluated synthetically. Results The difference of incidences of fever between the two groups was not significant( 25. 0% vs. 20. 0%,P > 0. 05). The VAS scores at different time points of the two groups were significantly lower than before analgesia( P < 0. 05),and the 3 and 4 h VAS scores of the observation group were lower than the control group( P < 0. 05),and the difference were statistically significant. Compared with the control group,the observation group had fewer drugs for ropivacaine and sufentanil( P < 0. 05),and the difference between the two groups was statistically significant. Conclusion The intermittent administration of epidural anesthesia will not have an adverse effect on the body temperature of the parturient,and can relieve the pain of the parturient and reduce the dosage of narcotic drugs. It is worth popularizing.
引文
[1]王红霞.硬膜外注射联合右美托咪定对产妇分娩镇痛的疗效[J].中国实用医刊,2017,44(12):108-110.
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[3]张永刚,梁浩,李红霞,等.舒芬太尼联合罗哌卡因在分娩镇痛中对产间发热的影响[J].中国实验诊断学,2017,21(12):2068-2071.
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[6]王雅聪,李淑丽,陈晓明.分娩潜伏期延长初产妇应用腰麻-硬膜外联合麻醉镇痛的前瞻性研究[J].中国妇幼保健,2017,32(23):5903-5905.
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[8]王雅聪,李淑丽,陈晓明.腰麻-硬膜外联合麻醉用于分娩潜伏期延长产妇镇痛的临床研究[J].实用临床医药杂志,2017,21(15):92-94.
[9]马马丽,李彩娟,冯善武.0.15%罗哌卡因硬膜外给药用于分娩镇痛中爆发痛的治疗效果[J].临床麻醉学杂志,2017,33(2):148-151.
[10]Imantalab V,Mirmansouri A,Sedighinejad A,et al.Comparing the effects of morphine sulfate and diclofenac suppositories on postoperative pain in coronary artery bypass graft patients[J].Anesth Pain Med,2014,4(4):e19423.
[11]方向东,谢雷,陈先侠.程控硬膜外间歇脉冲注入与持续背景输注用于分娩镇痛的比较[J].临床麻醉学杂志,2016,32(8):757-760.
[12]刘淑香,李国芳,苏江涛,等.硬膜外麻醉下剖宫产产妇应用小剂量去氧肾上腺素对产妇容量的影响[J].中国医药导报,2016,13(4):81-84.
[13]关正,刘琳,官彬,等.静脉输注右美托咪定联合规律性间断硬膜外注射分娩镇痛疗效分析[J].实用妇产科杂志,2016,32(3):225-228.
[14]Capogna G,Camorcia M,Stirparo S,et al.Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia:the effects on maternal motor function and labor outcome.A randomized double-blind study in nulliparous women[J].Anesth Analg,2011,113(4):826-831.
[2]杨粉兰.规律间断注射联合PCEA与持续背景输注联合PCEA在硬膜外分娩镇痛中的应用[J].中国妇幼保健,2017,32(17):4307-4310.
[3]张永刚,梁浩,李红霞,等.舒芬太尼联合罗哌卡因在分娩镇痛中对产间发热的影响[J].中国实验诊断学,2017,21(12):2068-2071.
[4]田艳峰,陶荣花.硬膜外间断注射不同浓度罗哌卡因联合芬太尼在硬膜外分娩镇痛中的应用[J].临床和实验医学杂志,2016,15(6):601-604.
[5]Nunes J,Nunes S,Veiga M,et al.A prospective,randomized,blinded-endpoint,controlled study-continuous epidural infusion versus programmed intermittent epidaral bolus in labor analgesia[J].Braz JAnesthesiol,2016,66(5):439-444.
[6]王雅聪,李淑丽,陈晓明.分娩潜伏期延长初产妇应用腰麻-硬膜外联合麻醉镇痛的前瞻性研究[J].中国妇幼保健,2017,32(23):5903-5905.
[7]视觉模拟评分法(Visual analogue scale,VAS)[J].临床和实验医学杂志,2013,12(23):1925.
[8]王雅聪,李淑丽,陈晓明.腰麻-硬膜外联合麻醉用于分娩潜伏期延长产妇镇痛的临床研究[J].实用临床医药杂志,2017,21(15):92-94.
[9]马马丽,李彩娟,冯善武.0.15%罗哌卡因硬膜外给药用于分娩镇痛中爆发痛的治疗效果[J].临床麻醉学杂志,2017,33(2):148-151.
[10]Imantalab V,Mirmansouri A,Sedighinejad A,et al.Comparing the effects of morphine sulfate and diclofenac suppositories on postoperative pain in coronary artery bypass graft patients[J].Anesth Pain Med,2014,4(4):e19423.
[11]方向东,谢雷,陈先侠.程控硬膜外间歇脉冲注入与持续背景输注用于分娩镇痛的比较[J].临床麻醉学杂志,2016,32(8):757-760.
[12]刘淑香,李国芳,苏江涛,等.硬膜外麻醉下剖宫产产妇应用小剂量去氧肾上腺素对产妇容量的影响[J].中国医药导报,2016,13(4):81-84.
[13]关正,刘琳,官彬,等.静脉输注右美托咪定联合规律性间断硬膜外注射分娩镇痛疗效分析[J].实用妇产科杂志,2016,32(3):225-228.
[14]Capogna G,Camorcia M,Stirparo S,et al.Programmed intermittent epidural bolus versus continuous epidural infusion for labor analgesia:the effects on maternal motor function and labor outcome.A randomized double-blind study in nulliparous women[J].Anesth Analg,2011,113(4):826-831.