摘要
目的分析罗哌卡因与利多卡因在局部浸润麻醉中对自然分娩中的镇痛效果及安全性。方法本研究为前瞻性随机对照研究,选取2021年1月至2022年1月南阳医学高等专科学校第一附属医院产科收治的120例产妇,年龄(28.54±0.18)岁,年龄范围为22~35岁。所有产妇均选择经阴道自然分娩,分娩后均予以局部浸润麻醉,根据用药方式不同将患者分为罗哌卡因组与利多卡因组,每组60例。比较两组产妇镇痛效果视觉模拟评分法(VAS)评分、产后基础体征,比较两组新生儿Apgar评分、脐动脉血气指标[动脉血氧分压(PaO_(2))、pH值、动脉血二氧化碳分压(PaCO_(2))],比较两组产妇产后不良事件发生情况。结果罗哌卡因组给药后5、10 min的VAS评分[(4.79±0.82)分、(4.04±0.88)分]高于利多卡因组[(4.43±0.26)分、(3.77±0.25)分],差异有统计学意义(P<0.05),两组产妇产后3、5、7 h的VAS评分比较,差异无统计学意义(P>0.05)。两组产妇产后心率、收缩压、舒张压、呼吸频率等基础体征比较,差异无统计学意义(P>0.05)。罗哌卡因组新生儿娩出后1、5、10 min时的Apgar评分[(7.35±0.86)分、(7.82±0.88)分、(8.24±0.85)分]高于利多卡因组[(7.02±0.11)分、(7.55±0.31)分、(7.95±0.32)分],差异有统计学意义(P<0.05)。罗哌卡因组新生儿脐PaO_(2)[(65.82±0.81)mmHg,1 mmHg=0.133 kPa]高于利多卡因组[(65.49±0.25)mmHg],pH(7.33±0.25)、PaCO_(2)[(66.34±0.27)mmHg]低于利多卡因组[(7.71±0.85)、(66.63±0.82)mmHg],差异有统计学意义(P<0.05)。罗哌卡因组产妇产后不良事件发生率[5.0%(3/60)]低于利多卡因组[16.7%(10/60)],差异有统计学意义(P<0.05)。结论在自然分娩后会阴修补术中应用罗哌卡因、利多卡因产后镇痛效果均较好,但利多卡因药效作用快,可在会阴修补术中迅速镇痛,而罗哌卡因药物毒性低,可有效避免产妇及新生儿发生不良预后的风险,为确保麻醉安全性,临床需在明确患者实际情况后合理选择相应药物。
Objective To analyze the analgesic effect and safety of ropivacaine and lidocaine in local infiltration anesthesia during natural labor.Methods This study was a prospective randomized controlled study,a total of 120 pregnant women admitted to the First Affiliated Hospital of Nanyang Medical College from January 2021 to January 2022,the age was(28.54±0.18)years old,ranging from 22 to 35 years old were selected.All the puerperas chose to deliver naturally via vagina,and were given local infiltration anesthesia after delivery.According to the different medication methods,the patients were divided into ropivacaine group and lidocaine group,with 60 cases in each group.Compare the visual analogue scale(VAS)score of analgesia effect and the basic physical signs of postpartum between the two groups,compare the Apgar score of newborns,umbilical artery blood gas index[prtial pressure of oxygen(PaO_(2)),pH,arterial partial pressure of carbon dioxide(PaCO_(2))]of the two groups,and compare the occurrence of postpartum adverse events between the two groups.Results The VAS scores of ropivacaine group at 5 and 10 minutes after administration[(4.79±0.82)scores,(4.04±0.88)scores]were higher than those of lidocaine group[(4.43±0.26)scores,(3.77±0.25)scores],the differences were statistically significant(P<0.05),the VAS scores of parturient women in the two groups were compared at 3,5 and 7 hours after delivery,the differences were not statistically significant(P>0.05).The heart rate,systolic blood pressure,diastolic blood pressure and respiratory rate were compared between the two groups,the differences were not statistically significant(P>0.05).The Apgar scores at 1,5,10 minutes after delivery in the ropivacaine group[(7.35±0.86)scores,(7.82±0.88)scores,(8.24±0.85)scores]were higher than those in the lidocaine group[(7.02±0.11)scores,(7.55±0.31)scores,(7.95±0.32)scores],the differences were statistically significant(P<0.05).The umbilical PaO_(2)[(65.82±0.81)mmHg,1 mmHg=0.133 kPa]in the ropivacaine group was higher than that in the lidocaine group[(65.49±0.25)mmHg],and pH(7.33±0.25),PaCO_(2)[(66.34±0.27)mmHg]were lower than that in the lidocaine group[(7.71±0.85),(66.63±0.82)mmHg],the differences were statistically significant(P<0.05).The incidence of postpartum adverse events in the ropivacaine group[5.0%(3/60)]was lower than that in the lidocaine group[16.7%(10/60)],the difference was statistically significant(P<0.05).Conclusions The effect of postpartum analgesia with ropivacaine and lidocaine is better in perineal repair after natural delivery,but the effect of lidocaine is fast,it can be used in perineal repair quickly,and the toxicity of ropivacaine is low,in order to ensure the safety of anesthesia,it is necessary to select appropriate drugs after knowing the actual condition of patients.
作者
李铮
徐国亭
吴昊
徐豫新
崔夢筱
Li Zheng;Xu Guoting;Wu Hao;Xu Yuxin;Cui Mengxiao(Department of Anesthesiology,The First Affiliated Hospital of Nanyang Medical College,Nanyang 473000,China)
出处
《中国临床实用医学》
2023年第1期47-51,共5页
China Clinical Practical Medicine
基金
河南省医学科技攻关项目(202100325)。
关键词
自然分娩
局部浸润
会阴修补术
罗哌卡因
利多卡因
Natural childbirth
Local infiltration
Perineum repair
Ropivacaine
Lidocaine
作者简介
通信作者:李铮,Email:lizhengzhengeg@163.com。
