羟考酮对罗哌卡因硬膜外分娩镇痛的影响

目的 探讨羟考酮复合罗哌卡因用于硬膜外分娩镇痛的安全性和有效性。方法 选择2017年2月至2018年1月国际和平妇幼保健院的112例初产妇,年龄21～35岁。随机分为2组:观察组(A组,n=57)采用0.1%罗哌卡因复合羟考酮硬膜外分娩镇痛;对照组(B组,n=55)采用0.1%罗哌卡因硬膜外分娩镇痛。观察两组起效时间、作用持续时间、镇痛效果、产程时间、分娩结局及血流动力学指标,记录母婴不良反应,评估新生儿Apgar评分,进行脐动脉血气分析。结果 A组镇痛起效时间快于B组,镇痛作用维持时间长于B组。两组产妇在镇痛后疼痛视觉模拟评分(visual analogue score,VAS)低于镇痛前(P<0.05);A组镇痛后2 h至宫口开全的镇痛效果明显优于B组,两组VAS评分差异有统计学意义(P<0.05)。比较两组产妇产程时间、分娩结局、Bromage评分、新生儿Apgar评分及脐动脉血气分析,差异均无统计学意义。两组产妇均无严重不良反应。结论 羟考酮能加快硬膜外镇痛起效时间,显著延长镇痛时间,增强硬膜外镇痛效果,且不影响产程,也不增加母婴并发症。

Effects of oxycodone on ropivacaine for epidural labor analgesia

Objective To investigate the effect of oxycodone on epidural ropivacaine analgesia during labor. Methods From Feb.,2017 to Jan., 2018 in International Peace Maternity and Child Health Hospital, 112 pregnancy nulliparous parturients were assigned randomly to two groups. The experiment group (group A, n=57) received 0.1% ropivacaine with 2 mg oxycodone, and the control group (group B, n=55) received 0.1% ropivacaine alone for labor analgesia. We observed the onset time of analgesia, duration of analgesia, labor duration, analgesia efficacy and hemodynamics index, and recorded Apgar scores and adverse reactions. The neonatal umbilical artery blood gas was analyzed. Results The onset time of analgesia was shorter in group A than that in group B. The duration of analgesia was longer in group A than that in group B. Visual analogue score (VAS) was lower in group A than that in group B from 2 h after analgesia to the full dilation of cervix, and the difference of VAS between the two groups had statistical significance (P<0.05). There was no significant differences in labor duration, Bromage scores, labor mode, blood pressure, blood gas analysis of neonatal umbilical artery and Apgar score between the two groups. No parturients had serious adverse effects in both groups. Conclusions Oxycodone with ropivacaine could accelerate the onset time of analgesia, prolong duration of analgesia and increase analgesic effect, but did not affect labor duration or increase adverse reaction during labor.