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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(P<0.05);与B组比较,A、C组T2、T3平均VAS评分明显降低(P<0.05);与C组比较,A、B组T1、T4平均VAS评分明显升高(P<0.05),A、B组罗哌卡因和舒芬太尼用量明显减少(P<0.05);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(P<0.05);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(P<0.05);与D组比较,A、B、C组PO2明显升高(P<0.05)。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。
Objective To observe the effects of different analgesic background doses on analgesia, labor and neonates during total epidural analgesia. Methods: From January 2014 to July 2015, 240 cases of primipara caused by spontaneous delivery in Pok Oi Hospital of Zhongshan were randomly divided into three groups, and no analgesia for labor was given as control group, with 60 cases in each group . In group A, patient controlled epidural analgesia (PCEA) was set at maternal uterine opening 1 ~ 3 cm, 3 ~ 8 cm and uterine opening to placenta delivery. The background dose was 0.1% ropivacaine 5 m L / h, 8-10 m L / h and 5 m L / h of 0.5 μg / m L sufentanil and an additional dose of 5 m L for a lock time of 30 min. The background dose during delivery was 6 m L / h. In group C, the background dose during delivery was 8 m L / h and the rest were in the same group A, while those in group D did not receive any analgesic drug during delivery. The mean visual analogue scale (VAS) score of the first stage of labor was recorded, including the latent period (T1), active stage (T2), second stage (T3) and third stage (T4) (Ta), active period (Tb), the second stage of labor (Tc), the third stage of labor (Td) of the time; record neonatal umbilical artery blood gas analysis results. Results Compared with group D, the mean VAS scores of T1 ~ T4 in groups A, B and C were significantly decreased (P <0.05). Compared with group B, the mean VAS scores of T2 and T3 in groups A and C were significantly decreased (P <0.05) Compared with group C, the mean VAS scores of T1 and T4 in group A and group B were significantly increased (P <0.05), and the dosage of ropivacaine and sufentanil in group A and group B was significantly decreased (P <0.05). Compared with group D, The time of Ta and Tb in group A and group B were significantly shortened, and the time of Tb and Tc in group C was significantly longer (P <0.05). There was no significant difference in Apgar score between group A and group B Blood PCO2 was significantly lower (P <0.05). Compared with group D, PO2 in groups A, B and C were significantly increased (P <0.05). Conclusion Adjusting the background dose of epidural analgesics in different stages of labor can provide satisfactory analgesic effect, which not only shortens the labor process, but also improves PO2 and PCO2 in neonates, which is beneficial to neonates.