不同镇痛背景剂量方案对硬膜外分娩镇痛的影响

目的观察在硬膜外全程分娩镇痛时不同镇痛背景剂量对镇痛效果、产程和新生儿的影响。方法选择2014年1月至2015年7月在中山市博爱医院自然分娩的初产妇240例,将要求分娩镇痛的产妇随机分为3组,不行分娩镇痛的为对照组,每组60例。A组在产妇宫口开1~3 cm、3~8 cm和宫口开全至胎盘娩出时设定硬膜外自控镇痛(patient controlled epidural analgesia,PCEA),背景剂量分别为0.1%罗哌卡因与0.5μg/m L舒芬太尼混合液5 m L/h、8~10 m L/h和5 m L/h,追加剂量为5 m L,锁定时间为30 min;B组在分娩全过程背景剂量为6 m L/h;C组在分娩全过程背景剂量为8 m L/h,其他同A组;D组分娩时不接受任何镇痛药物。记录第一产程潜伏期(T1)、活跃期(T2)、第二产程(T3)、第三产程(T4)的平均视觉模拟(visual analogue scale,VAS)评分,4组新生儿Apgar评分,4组的用药总量;记录第一产程潜伏期(Ta)、活跃期(Tb)、第二产程(Tc)、第三产程(Td)的时间;记录新生儿脐动脉血气分析结果。结果与D组比较,A、B、C组T1~T4平均VAS评分显著降低(P0.05);与B组比较,A、C组T2、T3平均VAS评分明显降低(P0.05);与C组比较,A、B组T1、T4平均VAS评分明显升高(P0.05),A、B组罗哌卡因和舒芬太尼用量明显减少(P0.05);与D组比较,A、B组Ta、Tb时间明显缩短,C组Tb、Tc时间明显延长(P0.05);4组新生儿Apgar评分无明显差异;与C组比较,A、B、D组新生儿脐动脉血PCO2明显降低(P0.05);与D组比较,A、B、C组PO2明显升高(P0.05)。结论在不同产程调整硬膜外腔镇痛药背景剂量,可提供满意的镇痛效果,不但能缩短产程,还能提高新生儿PO2和降低PCO2,对新生儿有利。

Impact of different epidural background dose on labor analgesia

Objective To evaluate the impact of different background dose of epidural analgesia in labor analgesia on analgesia effect, labor process and fetus. Methods 240 primiparae who hospitalized in Bo’ ai Hospital of Zhongshan City from January 2014 to July 2015 were selected,the women who asked for labor analgesia were divided into 3 groups,the women without labor analgesia were selected as control group,60 cases in each group. In group A, when the maternal uterine orifice opening was 1~3 cm, 3~8 cm and opened fully,the patient controlled epidural analgesia ( PCEA) background dose were 0. 1 % ropivacaine and 0. 5 g/mL sufentanil mixture 5 mL/h,8~10 mL/h and 5 mL/h respectively. Single dose was 5 mL, and the lock time was 30 min. The background dose of group B was 6 mL/h, and in group C was 8 mL/h, and the other was as the same as group A. The average VAS score was calculated at the latent period (T1),the active stage (T2) of the first stage, the second stage (T3), and the third stage (T4) of labor process. Calculated the neonatal Apgar score and total usage of the ropivacaine and sufentanil of the three groups. Recorded the time of the latent period ( TA) , the active period ( TB) , the second stage of labor( TC) , the third stage of labor ( TD) and the neonatal umbilical blood test results. Result Compared with group D, the average VAS of T1 ~T4 in group A, B, C were significantly lower ( P <0. 05), and the average VAS of T2,T3 in group A,C were significantly lower than in group B (P<0. 05). Compared with group C, T1, T4 average VAS score was significantly higher (P<0. 05) and the total usage of ropivacain and sufentanily were significantly lower in group A,B (P<0. 05). Compared with group D, Ta,Tb in group A, B were significantly shorter(P<0. 05) ; Tb、Tc in group C were significantly longer( P<0. 05 ) . Four groups of neonatal Apgar score had no significant difference. The PCO2 level of neonatal umbilical blood in group A,B,D were significantly lower(P<0. 05) comparing with group C. While the PO2 level in group A,B,C were significantly higer than in group D ( P <0. 05 ) . Conclusion Different dosage of anesthetic drug in different stages of labor process can supply satisfying effect of analgesia, and shorten the labor process, improve the neonatal PO2 , decrease the PCO2 level, which was beneficial for newborns.