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PCEA联合规律间断注入联合不同剂量罗哌卡因对产妇分娩镇痛效果及母婴结局的影响 预览

Effect of PCEA Combined with Regular Intermittent Injection and Different Doses of Ropivacaine on Analgesic Effect and Maternal and Infant Outcomes in Pregnant Women
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摘要 目的探讨PCEA(自控硬膜外镇痛)联合规律间断注入联合不同剂量罗哌卡因对产妇分娩镇痛效果及母婴结局的影响。方法随机选择2016年1月至2018年12月在海南现代妇女儿童医院分娩的产妇320例,按随机数字表法分为4组,A组PCEA联合规律间断注射、B组PCEA联合规律间断注射+罗哌卡因3mg、C组PCEA联合规律间断注射+罗哌卡因4mg,D组PCEA联合规律间断注射+罗哌卡因5mg。观察4组产妇的镇痛情况、分娩情况、新生儿情况等等。结果A组、B组、C组、D组中随着罗哌卡因剂量的增加镇痛起效时间依次缩短,维持时间依次延长,PCEA用药量依次减少,差异有统计学意义(P<0.05),4组间阻滞平面比较差异较小(P>0.05);镇痛前4组产妇的VAS评分比较差异无统计学意义(P>0.05),分娩镇痛后4组产妇的VAS评分均降低,各时间点随着罗哌卡因剂量的增加VAS评分逐渐下降,镇痛后1h、2h、3h、宫口开全时以及分娩时、分娩后1h的VAS评分各组比较差异有统计学意义(P<0.05);4组中随着罗哌卡因剂量的增加,下肢运动阻滞程度评分逐渐增加,组间差异有统计学意义(P<0.05),但是均未发生明显的运动阻滞;4组产妇的各个产程、分娩方式、新生儿1min、5minApgar评分相比,差异无统计学意义(P>0.05);4组产妇的不良反应比较差异无统计学意义(P>0.05)。结论PCEA联合规律间断注射联合罗哌卡因的镇痛效果较好,可有效降低VAS评分,降低PCEA药物用量,并且合适剂量的罗哌卡因对运动神经无明显的阻滞作用。 Objective To investigate the effect of PCEA combined with regular intermittent injection of ropivacaine at different doses on maternal and infant outcomes in pregnant women.Methods 320 parturients delivered in hainan modern women and chilren's from January 2016 to December 2018 were randomly divided into 4 group,group A were treated with PCEA combined with regular intermittent injection,group B were treated with PCEA combined with regular intermittent injection + ropivacaine 3 mg,group C were treated with PCEA combined with regular intermittent injection + ropivacaine 4 mg,group D were treated with PCEA combined with regular intermittent injection + ropivacaine 5 mg.We observed the analgesic effect,delivery and neonatal status of four groups of parturients.Results In group A,B,C and D,with the increase of ropivacaine dosage,the onset time was shortened,the maintenance time was prolonged,and the dosage of PCEA was decreased,the difference was statistically significant(P < 0.05).There was little difference between the four groups (P > 0.05).There was no significant difference in VAS scores among the four groups before analgesia (P > 0.05).VAS scores of the four groups decreased after labor analgesia.VAS scores gradually decreased with the increase of ropivacaine dosage at each time point.VAS scores of 1 h,2 h,3 h after analgesia,full time of uterine opening,1 h after delivery and 1 h after delivery had significant differences(P < 0.05).In the four groups,with the increase of ropivacaine dosage,the scores of lower limb motor block degree increased gradually,but no significant motor block occurred,and the difference between the groups was significant(P < 0.05).There was no significant difference in the different stages of labor,mode of delivery,neonatal 1 minute and 5 minute Apgar scores between the four groups (P > 0.05),and no difference in adverse reactions between the four groups (P > 0.05).Conclusions PCEA combined with regular intermittent injection of ropivacaine has better analgesic effect.It can effectively
作者 刘旺生 王金鸿 黄欢 LIU Wang-sheng;WANG Jin-hong;HUANG Huan(Dept.of Anesthesiology,Hainan Modern Women and Children's Hospital,Haikou Hainan 570100;Dept.of Obstetrics and Gynecology,Nanjing First People's Hospital,Nanjing Jiangsu 210000,China)
出处 《昆明医科大学学报》 CAS 2019年第7期41-46,共6页 Journal of Kunming Medical University
基金 国家自然科学基金资助项目(81741040).
关键词 自控硬膜外镇痛 规律间断注入 罗哌卡因 孕妇分娩 镇痛 母婴结局 PCEA (self-controlled epidural analgesia) Regular intermittent injection Ropivacaine Pregnant women delivery Analgesia Maternal and infant outcomes
作者简介 刘旺生(1977-),男,江西九江人,医学学士,主治医师,主要从事产科手术麻醉分娩镇痛临床工作。
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