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目的探讨盐酸罗哌卡因与布比卡因在无痛分娩中的镇痛效果对比及对产妇应激反应影响。方法收集宝鸡市第五人民医院2015年6月—2016年12月收治的自愿采用分娩镇痛的产妇210例,随机数字表法分为A组和B组,同时同期收取105例不愿采取无痛分娩产妇为对照组,A组给予罗哌卡因联合芬太尼麻醉,B组给予布比卡因联合芬太尼麻醉,观察镇痛效果及对产妇应激反应的影响。结果麻醉前VAS评分组间差异无统计学意义;麻醉后与麻醉前相比,A和B组VAS评分均降低,对照组升高,差异具有统计学意义(P<0.05);且A和B组VAS评分明显低于对照组,差异具有统计学意义(P<0.05);A组评分低于B组,但是差异无统计学意义。经过评估两组MBS评分差异无统计学意义。1、5 min Apgar评分在3组间差异无统计学意义;与1 min Apgar评分相比,3组5 min Apgar评分均升高,差异具有统计学意义(P<0.05)。B组和对照组血糖均升高,差异具有统计学意义(P<0.05);麻醉前A组和B组皮质醇水平高于对照组,差异具有统计学意义(P<0.05);麻醉后B组高于对照组,A组低于对照组,A组低于B组水平,差异具有统计学意义(P<0.05)。麻醉前A组和B组胰岛素/血糖比值低于对照组,麻醉后A组和B组水平高于对照组,A组低于B组水平,差异具有统计学意义(P<0.05)。结论产妇分娩镇痛采用罗哌卡因自控输注效果显著,并且可以减轻产妇应激反应,值得临床推荐。
Objective To investigate the analgesic effects of ropivacaine hydrochloride and bupivacaine in painless childbirth and its effects on maternal stress response. Methods A total of 210 maternal women who used labor analgesia during the period from June 2015 to December 2016 in Baoji Fifth People’s Hospital were collected and divided into groups A and B randomly. The same period, 105 cases were reluctant to take Pain was given to the pregnant women as control group, group A was given anesthesia with ropivacaine and fentanyl, and group B was anesthetized with bupivacaine and fentanyl to observe the effect of analgesia and the effect on maternal stress. Results There was no significant difference in VAS score before anesthesia. Compared with those before anesthesia, VAS scores in both groups A and B were lower than those before anesthesia, and the difference was statistically significant (P <0.05); and A and B Group VAS score was significantly lower than the control group, the difference was statistically significant (P <0.05); A group score lower than the B group, but the difference was not statistically significant. After assessment of the two groups MBS score difference was not statistically significant. The Apgar score at 1 and 5 min was not significantly different among the three groups. Compared with 1 min Apgar score, Apgar scores at 5 min in each group were significantly increased (P <0.05). The blood glucose of group B and control group were increased, the difference was statistically significant (P <0.05). The levels of cortisol in group A and group B before anesthesia were significantly higher than those in control group (P <0.05) Group A was lower than control group, Group A was lower than Group B, the difference was statistically significant (P <0.05). Before anesthesia, the ratio of insulin to blood glucose in group A and group B was lower than that in control group. The levels in group A and group B after anesthesia were higher than those in control group, while those in group A were lower than those in group B (P <0.05). Conclusion Maternal labor analgesia with ropivacaine-controlled infusion of significant effect, and can reduce maternal stress response, it is worth recommending.