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[摘要]
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。
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[Abstract]
Objective To investigate analgesic effect of ropivacaine and bupivacaine in painless childbirth and response to maternal stress. Methods The voluntary labor analgesia maternal 210 cases in The Fifth People's Hospital of Baoji City from June 2015 to December 2016 were randomly divided into A group and B group. 105 cases collected during the same period to take maternal painless childbirth as the control group, A group was given ropivacaine combined with fentanyl anesthesia, B group received bupivacaine combined with fentanyl anesthesia, observe the analgesic effect and the effect on maternal stress response. Results The difference between the groups before anesthesia score VAS was not statistically significant. After anesthesia compared with before anesthesia, A group and B VAS scores were reduced, the control group increased, the difference was statistically significant (P<0.05). And VAS in A and B group was significantly lower than the control group, the difference was statistically significant (P<0.05). After evaluation, there was no statistical difference between the two groups in MBS score. 1, 5 min, Apgar scores were not statistically significant in the 3 groups. Compared with the 1 min Apgar score, Apgar scores in 3 and 5 min were increased, the difference was statistically significant (P<0.05). Blood glucose levels in B group and control group were increased (P<0.05). Cortisol levels in group A and group B before anesthesia were higher than the control group (P<0.05); After anesthesia, cortisol levels in group B was higher than the control group, A group was lower than that in group B (P<0.05). Before anesthesia, the ratio of insulin/blood glucose in the A group and the B group was lower than that in the control group (P<0.05), and that in A group and B group after anesthesia was higher than that in the control group, and the level of A group was lower than that of the B group (P<0.05). Conclusion maternal analgesia with patient-controlled infusion effect, and can reduce maternal stress reaction, it is worthy of recommendation.
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