低浓度罗哌卡因对分娩镇痛时产妇产力的影响

Yongying Pan, Qingning Wang, Xinxu Ou, Pin Li, Xing-rong Song
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Their age, body mass index(BMI), gestational age, cesarean section rate, forceps delivery rate, the duration of the first and second stages of labor, the rate of oxytocin use, and blood loss 2 h after delivery were recorded. The maternal pain was evaluated on the basis of Visual Analogue Scale (VAS) scores at the beginning of labor analgesia (T1), 15 min after labor analgesia (T2), 30 min after labor analgesia (T3) and 45 min after labor analgesia (T4). Then, the parameters of electromyography (EMG) burst wave energy were recorded, including the number and duration of burst waves, root mean square (RMS), and power and peak frequency, so as to comprehensively evaluate the contraction of the uterine and abdominal muscles. \n \n \nResults \nThere was no significant difference in age, BMI, gestational age, cesarean section rate, forceps delivery rate, and blood loss 2 h after delivery among the three groups (P>0.05). 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引用次数: 0

摘要

目的探讨低浓度罗哌卡因对分娩镇痛时子宫和腹肌收缩的影响。方法选择150名希望顺产的初产妇。然后,将100名初产妇按随机数表法分为两组:0.062 5%罗哌卡因组(罗哌卡因,n=50)和0.062 5%左旋布比卡因组(左旋布比卡卡因,n=5)。同时,将50名未采取阴道分娩镇痛措施的初产妇作为对照组。记录他们的年龄、体重指数(BMI)、孕龄、剖宫产率、产钳分娩率、第一和第二产程的持续时间、催产素的使用率以及产后2小时的失血量。根据分娩镇痛开始时(T1)、分娩镇痛后15分钟(T2)、分娩止痛后30分钟(T3)和分娩镇痛后45分钟(T4)的视觉模拟量表(VAS)评分评估产妇疼痛。然后,记录肌电图(EMG)爆发波能量的参数,包括爆发波的数量和持续时间、均方根(RMS)、功率和峰值频率,以全面评估子宫和腹肌的收缩情况。结果三组患者的年龄、体重指数、孕龄、剖宫产率、产钳分娩率、产后2h失血量均无显著差异(P>0.05),催产素使用率显著增加(P<0.05)。与对照组相比,罗哌卡因组和左旋布比卡因组在T2、T3和T4的母体VAS评分明显降低(P<0.05),在分娩的第一阶段,罗哌嗪组和左旋布比卡因组的子宫肌EMG均方根值与对照组比较明显降低(P<0.01),与对照组和罗哌卡因组相比,左旋布比卡因组的母体力量显著降低(P<0.05)。在第二产程,与对照组及罗哌卡因相比,左旋布比卡因组子宫肌EMG爆发波持续时间显著延长(P<0.05),结论0.062 5%罗哌卡因用于硬膜外镇痛效果良好,对产妇劳动强度无明显影响,且不延长产程。关键词:罗哌卡因;左布比卡因;分娩镇痛;肌电图;劳动阶段
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Effects of a low concentration of ropivacaine on maternal labor force during labor analgesia
Objective To investigate the effects of a low concentration of ropivacaine on the contraction of the uterine and abdominal muscles during labor analgesia. Methods One hundred and fifty primiparous women who expected to have a natural birth were selected. Then, 100 primiparous women were divided into two groups according to the random number table method: a 0.062 5% ropivacaine group (group ropivacaine, n=50) and a 0.062 5% levobupivacaine group (group levobupivacaine, n=50). Meanwhile, 50 primiparous women who did not take analgesic measures during vaginal delivery were set as a control group. Their age, body mass index(BMI), gestational age, cesarean section rate, forceps delivery rate, the duration of the first and second stages of labor, the rate of oxytocin use, and blood loss 2 h after delivery were recorded. The maternal pain was evaluated on the basis of Visual Analogue Scale (VAS) scores at the beginning of labor analgesia (T1), 15 min after labor analgesia (T2), 30 min after labor analgesia (T3) and 45 min after labor analgesia (T4). Then, the parameters of electromyography (EMG) burst wave energy were recorded, including the number and duration of burst waves, root mean square (RMS), and power and peak frequency, so as to comprehensively evaluate the contraction of the uterine and abdominal muscles. Results There was no significant difference in age, BMI, gestational age, cesarean section rate, forceps delivery rate, and blood loss 2 h after delivery among the three groups (P>0.05). Compared with groups control and ropivacaine, group levobupivacaine presented significantly extended duration of the first and second stages of labor, and marked increases in the rate of oxytocin use (P<0.05). Compared with group control, groups ropivacaine and levobupivacaine showed obviously decreased maternal VAS scores at T2, T3, and T4 (P<0.05). In the first stage of labor, compared with group control, the RMS of uterine muscle EMG in groups ropivacaine and levobupivacaine significantly reduced (P<0.05), compared with groups control and ropivacaine, the maternal power of group levobupivacaine significantly reduced (P<0.05). In the second stage of labor, compared with groups control and ropivacaine, group levobupivacaine presented significantly extended duration of EMG burst wave in the uterine muscle (P<0.05), compared with group control, groups ropivacaine and levobupivacaine showed significantly reduced RMS (P<0.05). Conclusions The use of 0.062 5% ropivacaine for epidural analgesia can achieve good effects, without significant impacts on maternal labor force, and does not prolong labor stage. Key words: Ropivacaine; Levobupivacaine; Labor analgesia; Electromyography; Labor stage
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