地佐辛联合罗哌卡因用于硬膜外分娩镇痛对胎儿及产妇血流指数的影响
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摘要
目的:探讨将罗哌卡因联合地佐辛应用在硬膜外分娩镇痛对胎儿及产妇的影响。方法:研究对象选取2018年3月至2019年3月,在承德妇幼保健院产科选择顺产的初产妇180例,依据患者入院的病志号码随机排列方法将所有产妇均分成两组,研究组(D组)和对照组(C组),每组90例。C组:不接受硬膜外分娩镇痛; D组:PECA镇痛泵:0.125%罗哌卡因+地佐辛5mg+0.9%氯化钠注射液,共100mL,背景剂量为10mL/h,追加剂量8mL,锁定时间为20min。观察指标:两组的产程耗时、分娩的出血量、脐动脉的血气结果以及新生儿Apgar评分;应用超声技术观察两组胎儿的脐动脉、大脑中动脉以及母体的子宫动脉的PI值、RI值以及S/D值;记录两组产妇不良反应,观察时间:镇痛前30min(T1)、镇痛后10min(T2)、镇痛后30min(T3)、镇痛后1h(T4)、镇痛后2h(T5)、宫口开全(T6);记录两组产妇不良反应。结果:两组患者产程耗时、分娩出血量、血气分析以及新生儿Apgar评分无统计学差异(P>0.05)。在T2时,研究组子宫动脉血流测得S值和D值高于对照组,且具有统计学差异(P <0.05);在不同时间点,两组的胎儿大脑中动脉和胎儿脐动脉的PI值、RI值以及S/D无统计学差异(P>0.05);两组不良反应无统计学差异(P>0.05)。结论:罗哌卡因联合地佐辛应用于硬膜外的分娩镇痛可以显著缓解产妇的痛苦且对婴儿及产妇是安全的。
Objective: To explore the effect of ropivacaine combined with dizosin on epidural labor analgesia on fetus and puerpera. Methods: The subjects were selected from March 2018 to March 2019 in the obstetrics department of Chengde Maternal and Child Health Hospital. 180 cases of primipara with spontaneous delivery were selected. All the primipara were divided into two groups according to the random arrangement method of the patient's admission number. The study group( group D) and the control group( group C) had90 cases in each group. Group C: no epidural labor analgesia; Group D: PECA analgesia pump: 0.125% ropivacaine + 5 mg of Dzosin + 0.9% sodium chloride injection,a total of 100 ml,background dose of 10 ml/h,additional dose of 8 ml,locking time of 20 minutes. Observed indicators: the duration of labor,the amount of bleeding during delivery,umbilical artery blood gas results and neonatal Apgar score in the two groups. The PI,RI and S/D values of umbilical artery,middle cerebral artery and uterine artery of the two groups were observed by ultrasonography. The adverse reactions of the two groups were recorded. The observation time was 30 minutes before analgesia( T1),10 minutes after analgesia( T2),30 minutes after analgesia( T3),1 hour after analgesia( T4),2 hours after analgesia( T5),and uterine opening( T6). Maternal adverse reactions were recorded in two groups. Results: There were no significant differences in labor duration,blood gas analysis and Apgar score between the two groups( P >0.05). At T2,the S and D values of uterine artery blood flow in the study group were higher than those in the control group( P <0.05). At different time points,there were no significant differences in P I,RI and S/D between the two groups( P >0.05). There was no significant difference in adverse reactions between the two groups( P >0.05). Conclusion: epidural analgesia with ropivacaine combined with dizosin can significantly relieve the pain of parturient without adverse effects on infants and parturient.
Objective: To explore the effect of ropivacaine combined with dizosin on epidural labor analgesia on fetus and puerpera. Methods: The subjects were selected from March 2018 to March 2019 in the obstetrics department of Chengde Maternal and Child Health Hospital. 180 cases of primipara with spontaneous delivery were selected. All the primipara were divided into two groups according to the random arrangement method of the patient's admission number. The study group( group D) and the control group( group C) had90 cases in each group. Group C: no epidural labor analgesia; Group D: PECA analgesia pump: 0.125% ropivacaine + 5 mg of Dzosin + 0.9% sodium chloride injection,a total of 100 ml,background dose of 10 ml/h,additional dose of 8 ml,locking time of 20 minutes. Observed indicators: the duration of labor,the amount of bleeding during delivery,umbilical artery blood gas results and neonatal Apgar score in the two groups. The PI,RI and S/D values of umbilical artery,middle cerebral artery and uterine artery of the two groups were observed by ultrasonography. The adverse reactions of the two groups were recorded. The observation time was 30 minutes before analgesia( T1),10 minutes after analgesia( T2),30 minutes after analgesia( T3),1 hour after analgesia( T4),2 hours after analgesia( T5),and uterine opening( T6). Maternal adverse reactions were recorded in two groups. Results: There were no significant differences in labor duration,blood gas analysis and Apgar score between the two groups( P >0.05). At T2,the S and D values of uterine artery blood flow in the study group were higher than those in the control group( P <0.05). At different time points,there were no significant differences in P I,RI and S/D between the two groups( P >0.05). There was no significant difference in adverse reactions between the two groups( P >0.05). Conclusion: epidural analgesia with ropivacaine combined with dizosin can significantly relieve the pain of parturient without adverse effects on infants and parturient.
引文
[1] Riazanova OV,Alexandrovich YS,Ioscovich AM. The relationship between labor pain management,cortisol level and risk of postpartum depression development:a prospective nonrandomized observational monocentric trial[J]. Rom Anaesth Intensive Care,2018,25(2):123~130.
[2]李冰,陈绪军,郭艳,等.不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用[J].临床麻醉学杂志,2016,32(4):361~365.
[3]吴玲玲,尹玉竹,饶燕珍,等.腰硬联合麻醉分娩镇痛转剖宫产的指征分析[J].中山大学学报(医学科学版),2015,36(5):753~757.
[4] Baliuliene V,Macas A,Rimaitis K. The optimal concentration of bupivacaine and levobupivacaine for labor pain management using patient-controlled epidural analgesia:a double-blind,randomized controlled trial[J]. Int Obstet Anesth,2018,35:17~25.
[5] Yuksel H,Cayir Y,Kosan Z,et al. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration:a randomized controlled trial[J]. Integr Med,2017,15(6):456~461.
[6] Genc KR,Demirci N,Ender YA,et al. Effects of intradermal sterile water injections in women with low back pain in labor:a randomized,controlled,clinical trial[J]. Balkan Med,2018,35(2):148~154.
[7] Ranjbaran M,Khorsandi M,Matourypour P,et al. Effect of massage therapy on labor pain reduction in primiparous women:a systematic review and meta-analysis of randomized controlled clinical trials in iran[J]. Iran Nurs Midwifery Res,2017,22(4):257~261.
[8] Mdc L,Sgnd G,Ape P,et al. The color of pain:racial iniquities in prenatal care and childbirth in brazil[J]. Cad Saude Publica,2017,33:112~125.
[9] van Erp M,Ortner C,Jochberger S,et al. Recent standards in management of obstetric anesthesia[J]. Wien Med Wochenschr,2017,167(15-16):374~389.
[2]李冰,陈绪军,郭艳,等.不同浓度罗哌卡因复合舒芬太尼在硬膜外阶梯式分娩镇痛中的应用[J].临床麻醉学杂志,2016,32(4):361~365.
[3]吴玲玲,尹玉竹,饶燕珍,等.腰硬联合麻醉分娩镇痛转剖宫产的指征分析[J].中山大学学报(医学科学版),2015,36(5):753~757.
[4] Baliuliene V,Macas A,Rimaitis K. The optimal concentration of bupivacaine and levobupivacaine for labor pain management using patient-controlled epidural analgesia:a double-blind,randomized controlled trial[J]. Int Obstet Anesth,2018,35:17~25.
[5] Yuksel H,Cayir Y,Kosan Z,et al. Effectiveness of breathing exercises during the second stage of labor on labor pain and duration:a randomized controlled trial[J]. Integr Med,2017,15(6):456~461.
[6] Genc KR,Demirci N,Ender YA,et al. Effects of intradermal sterile water injections in women with low back pain in labor:a randomized,controlled,clinical trial[J]. Balkan Med,2018,35(2):148~154.
[7] Ranjbaran M,Khorsandi M,Matourypour P,et al. Effect of massage therapy on labor pain reduction in primiparous women:a systematic review and meta-analysis of randomized controlled clinical trials in iran[J]. Iran Nurs Midwifery Res,2017,22(4):257~261.
[8] Mdc L,Sgnd G,Ape P,et al. The color of pain:racial iniquities in prenatal care and childbirth in brazil[J]. Cad Saude Publica,2017,33:112~125.
[9] van Erp M,Ortner C,Jochberger S,et al. Recent standards in management of obstetric anesthesia[J]. Wien Med Wochenschr,2017,167(15-16):374~389.