检索历史 清除

目的:分析罗哌卡因复合舒芬太尼硬膜外麻醉用于顺产产妇镇痛的临床效果。方法:队列研究。抽取2020年2月至2023年2月于南阳市中心医院顺产产妇76例，按随机数字表法分为对照组和观察组，每组38例。对照组予以罗哌卡因硬膜外麻醉，观察组予以罗哌卡因复合舒芬太尼硬膜外麻醉。比较两组镇痛效果、镇痛指标(镇痛起效时间、镇痛维持时间、产时出血量)、产程时间(第一、二、三产程)、视觉模拟评分法(VAS)评分、应激反应[促肾上腺皮质激素(ACTH)、皮质醇(Cor)、去甲肾上腺素(NE)]水平、新生儿Apgar评分。结果:观察组镇痛总有效率(94.74%，36/38)高于对照组(78.95%，30/38)， P<0.05。两组产时出血量比较差异未见统计学意义( P>0.05)；观察组镇痛起效时间短于对照组，镇痛维持时间长于对照组( P<0.05)。观察组第一产程短于对照组( P<0.05)，两组第二、三产程比较差异未见统计学意义( P>0.05)。观察组第一、二、三产程VAS评分均低于对照组( P均<0.05)。分娩后，观察组ACTH、Cor、NE水平均低于对照组( P均<0.05)。出生后1、5 min，两组Apgar评分比较差异未见统计学意义( P>0.05)。 结论:罗哌卡因复合舒芬太尼硬膜外麻醉用于顺产产妇的镇痛效果较佳，可缩短镇痛起效时间，延长镇痛维持时间，缩短生产时间，减轻分娩疼痛及应激反应，且对新生儿健康状况影响较小。

Objective:To analyze the clinical effect of epidural anesthesia with ropivacaine combined with sufentanil on parturients.Methods:A total of 76 parturients who gave spontaneous delivery in Nanyang Central Hospital from February 2020 to February 2023 were selected for the cohort study. And they were divided into a control group and an observation group according to random number table method, with 38 cases in each group. The control group was given epidural anesthesia with ropivacaine, and the observation group was given epidural anesthesia with ropivacaine combined with sufentanil. The analgesic effect, analgesic indexes (analgesic onset time, analgesic maintenance time and blood loss during delivery), labor time of the first stage, the second stage and the third stage, visual analogue scale (VAS) score, stress response evaluated by adrenocorticotropic hormone (ACTH), cortisol (Cor) and norepinephrine (NE), and Apgar score of newborns were compared between the two groups.Results:The total effective rate of analgesia in the observation group (94.74%, 36/38) was higher than that in the control group (78.95%, 30/38), P<0.05. There was no significant difference in blood loss during delivery between the two groups ( P>0.05). The observation group had shorter analgesic onset time and longer analgesic maintenance time compared with the control group ( P<0.05). The labor time of the first stage in the observation group was shorter than that in the control group ( P<0.05), but there was no significant difference in labor time of the second and the third stages between the two groups ( P>0.05). The VAS scores in the first, second and third stages of labor in the observation group were lower than those in the control group (all P<0.05). After delivery, the levels of ACTH, Cor and NE in the observation group were lower than those in the control group (all P<0.05). There was no significant difference in Apgar score between the two groups at 1 and 5 minutes after birth ( P>0.05). Conclusions:The epidural anesthesia with ropivacaine combined with sufentanil has better analgesic effects on parturients. This protocol can shorten the analgesic onset time, prolong the analgesic maintenance time, shorten the labor time, and reduce labor pain and stress reaction, with little impact on the health of newborns.