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| 不同浓度罗哌卡因复合舒芬太尼分娩镇痛对产妇产间发热的影响 |
| Effects of different concentrations of ropivacaine for labor analgesia on maternal inpartum fever |
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| DOI：10.12089/jca.2019.04.004 |
| 中文关键词: 分娩镇痛 产间发热 致热因子 罗哌卡因 |
| 英文关键词: Labor analgesia Intrapartum fever Cytokines Ropivacaine |
| 基金项目:嘉定区卫生计生系统新一轮医学重点学科项目（2017ZD08）；上海市科委产学研医合作项目（16DZ1930307） |
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| 中文摘要: |
目的 研究不同浓度罗哌卡因复合舒芬太尼硬膜外注射用于分娩镇痛对产妇产间发热及致热因子的影响。
方法 适合阴道分娩、自愿要求分娩镇痛的初产妇120例，孕37～41周，年龄20～35岁，ASA I或Ⅱ级，随机分为三组：0.075%罗哌卡因组（A组）、0.1%罗哌卡因组（B组）和0.125%罗哌卡因组（C组），每组40例。宫口扩张至3 cm时实施硬膜外分娩镇痛，A组0.075%罗哌卡因+舒芬太尼0.5 μg/ml；B组0.1%罗哌卡因+舒芬太尼0.5 μg/ml；C组0.125%罗哌卡因+舒芬太尼0.5 μg/ml。记录镇痛后1、2、3、4和5 h、胎儿娩出即刻、分娩后2 h产妇鼓膜温度；分别在镇痛前、胎儿娩出即刻及分娩后2 h采集产妇静脉血，测定血清IL-1β、IL-6、TNF-α浓度；记录产程时间；采用改良Bromage法评定三组产妇在镇痛后1 h及胎儿娩出即刻的运动神经阻滞程度。
结果 与镇痛前比较，镇痛后5 h及胎儿娩出即刻三组鼓膜温度明显升高，C组发热率明显高于A组和B组（P<0.05）。与镇痛前比较，胎儿娩出即刻三组血清IL-1β、IL-6、TNF-α浓度明显升高（P<0.05）。C组第二产程和镇痛时间明显长于A组和B组，B组第二产程和镇痛时间明显长于A组（P<0.05）。三组运动神经阻滞程度差异无统计学意义。
结论 不同浓度罗哌卡因复合舒芬太尼硬膜外注射用于分娩镇痛均能产生良好的镇痛效果，低浓度罗哌卡因分娩镇痛产妇发热率低，产妇分娩期间发热与致热因子水平升高相关。 |
| 英文摘要: |
Objective To investigate the effect of different concentrations of ropivacaine combined with sufentanil for epidural analgesia on maternal inpartum fever and endogenous pyrogen.
Methods A total of 120 primigravidas, ASA physical status Ⅰ or Ⅱ were randomly divided into three groups of 40 patients: group A 0.075% ropivacaine + sufentanil 0.5 μg/ml, group B 0.1% ropivacaine + sufentanil 0.5 μg/ml, group C 0.125% ropivacaine + sufentanil 0.5 ug/ml．The epidural analgesia was performed by a fixed anesthesiologist when the uterine stenosis was dilated to about 3 cm. The measurements included the incidence of maternal fever, IL-1β，IL-6，TNF-α in maternal, labor time and neonatal Apgar score.
Results Group C had a higer significantly incidence of maternal fever than group B and group A (P<0.05). The duration of 2nd stage of labor and epidural analgesia in group C were longer than those in group B and group A (P<0.05). Endogenous pyrogen in maternal serum rose during labor in each group, but no statistical difference was detected among the three groups at respective time points.
Conclusion Different concentrations of ropivacaine epidural analgesia could produce good analgesic effect, the lower concentrations of ropivacaine have the lower incidence of maternal fever. The maternal inpartum fever was related to the increase of endogenous pyrogen. |
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