2020 年第 2 期 第 15 卷

小剂量低浓度罗哌卡因用于妊娠期高血压产妇分娩镇痛的临床研究

Clinical study on low dose and low concentration of ropivacaine for labor analgesia in parturients with pregnancy-induced hypertension

作者：刘野徐铭军赵国胜康凯白云波

英文作者：

单位：首都医科大学附属北京妇产医院麻醉科100026

英文单位：

关键词：妊娠期高血压；分娩镇痛；罗哌卡因；低浓度；产程；不良反应

英文关键词：

• 摘要：

• 【摘要】目的    观察小剂量低浓度罗哌卡因在妊娠期高血压产妇分娩镇痛中的应用效果。方法    选取2015年8月至2018年8月在首都医科大学附属北京妇产医院住院分娩的妊娠期高血压疾病产妇136例，按照随机数字表法分为S组和E组，每组68例。S组产妇采用低剂量0.1%罗哌卡因＋舒芬太尼蛛网膜下腔-硬膜外联合镇痛；E组产妇采用低剂量0.1%罗哌卡因＋舒芬太尼硬膜外镇痛。分析2组镇痛前后疼痛视觉模拟量表（VAS）评分、镇痛起效时间、运动神经阻滞评分、产程时间和分娩方式、产妇生命体征和胎心率、产妇不良事件、新生儿Apgar评分以及脐动脉血气等指标。结果    S组疼痛完全缓解时间明显短于E组［（3.7±1.4）min比（11.2±4.6）min］，第一产程平均VAS评分明显低于E组［（0.9±0.3）分比（1.8±0.6）分］，差异均有统计学意义（均P＜0.01）；S组平均运动神经阻滞评分稍高于E组［（0.90±0.04）分比（0.80±0.03）分］，但差异无统计学意义（P＞0.05）。2组产妇第一产程时间、第二产程时间、使用缩宫素比例、分娩中降压治疗比例、器械助产及剖宫产比例比较，差异均无统计学意义（均P＞0.05）。镇痛前2组平均动脉压和心率差异无统计学意义（P＞0.05）；镇痛后5 min时及宫颈完全扩张后S组平均动脉压和心率均明显低于E组［（86±7）mmHg（1 mmHg=0.133 kPa）比（104±9）mmHg、（86±8）mmHg比（94±9）mmHg,（80±8）次/min比（90±8）次/min、（80±6）次/min比（87±8）次/min］，差异均有统计学意义（均P＜0.01）；2组镇痛后15、30、60 min时的平均动脉压和心率均明显低于镇痛前，差异均有统计学意义（均P＜0.05）。2组胎心率各时间点比较差异均无统计学意义（均P＞0.05）。2组产妇主要不良反应及并发症发生率、新生儿体质量、1 min Apgar评分、脐动脉血气指标比较，差异均无统计学差异（均P＞0.05）。结论    小剂量低浓度罗哌卡因蛛网膜下腔-硬膜外联合镇痛具有起效快、运动阻滞轻等特点，可安全有效地应用于妊娠高血压疾病产妇的分娩镇痛。

• 【Abstract】Objective    To observe the clinical efficacy of low dose and low concentration of ropivacaine for labor analgesia in parturients with pregnancy-induced hypertension. Methods    From August 2015 to August 2018, 136 parturients with pregnancy-induced hypertension waiting for delivery in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were randomly divided into group S and group E, with 68 cases in each group. Group S had low dose 0.1% ropivacaine＋sulfentanyl subarachnoid analgesia combined with epidural analgesia. Group E had low dose 0.1% ropivacaine＋sulfentanyl epidural analgesia. Intensity of pain assessed by Visual Analogue Scale（VAS）, onset time of analgesia, motor nerve block, labor duration and method, vital signs of parturients and fetal heart rate, adverse maternal events, neonatal Apgar score and umbilical cord blood gas indicators were analyzed. Results    Pain relief time in group S was significantly shorter and VAS score during the first stage of labor was significantly lower than those in group E［（3.7±1.4）min vs （11.2±4.6）min, （0.9±0.3） vs （1.8±0.6）］(both P＜0.01). Motor nerve block score in group S was higher than that in group E［（0.90±0.04） vs （0.80±0.03）］ but the difference was not statistically significant(P＞0.05). There were no significant differences in labor duration, use of oxytocin, antihypertensive treatment during delivery, device-assistant delivery and uterine-incision delivery between groups（all P＞0.05）. There were no significant differences in mean arterial pressure and heart rate between groups before analgesia（P＞0.05）. At 5 min after analgesia and after complete dilatation of cervix, mean arterial pressure and heart rate in group S were significantly lower than those in group E［（86±7）mmHg vs （104±9）mmHg, （86±8）mmHg vs （94±9）mmHg； （80±8）times/min vs （90±8）times/min, （80±6）times/min vs （87±8）times/min］（all P＜0.01）. At 15, 30 and 60 min after analgesia, mean arterial pressure and heart rate were significantly lower than those before analgesia in both groups（all P＜0.05）. There were no significant differences in fetal heart rate, adverse maternal events, neonatal body mass, 1 min Apgar score and umbilical cord blood gas indexes between groups(all P＞0.05). Conclusion    Low dose and low concentration of ropivacaine subarachnoid analgesia combined with epidural analgesia shows quick effect and low motor block; it can be safely applied for labor analgesia in parturients with pregnancy-induced hypertension.