目的 探究硬膜外分娩镇痛中罗哌卡因+舒芬太尼规律间断给药与恒速持续给药对体温升高的影响.方法 选取宣城市中心医院在2015年1至12月期间收治的、符合纳入标准的行硬膜外分娩镇痛初产妇200例.根据给药方式的不同,分为间断组(n=100)和持续组(n=100).间断组单次给予10mL剂量,持续组按10mL/h恒速持续给药,药物剂量为0.08%罗哌卡因8mg+0.4μg/mL舒芬太尼4μg.记录两组在镇痛前、镇痛后60、120、180、240、300min、分娩时及分娩后60min时的产间发热例数、感觉平面阻滞、白细胞介素-6、鼓膜体温等情况;对比两组产妇及其新生儿产程时间、镇痛时间、新生儿体重、阿氏评分等硬膜外阻滞各项指标.结果 两组产间发热及感觉平面阻滞在各时段均无明显差异(F值分别为1.52、0.79,均P>0.05);与镇痛前相比,两组在镇痛后240、300min、分娩时及分娩后60min时的鼓膜体温均所升高,差异具有统计学意义(F=3.48,P<0.05);两组在所有镇痛后时段的白细胞介素-6水平均较镇痛前高,且持续组升高更为明显(F值分别为3.42、4.00,均P<0.05);持续组在镇痛后180、240min时的VAS评分较间断组高(F=3.23,P<0.05);持续组罗哌卡因及舒芬太尼的用量较间断组高,差异具有统计学意义(t值分别为4.63、6.16,均P<0.05).结论 硬膜外分娩镇痛中规律间断给药与恒速持续给药产生的产间发热例数无明显差异,体温升高可能与白细胞介素-6有关.规律间断给药使用药物剂量较小,镇痛效果更佳.%Objective To explore the effect of ropivacaine and sulfentanyl administrated intermittently or continuously at constant rate during epidural labor analgesia on temperature rise.Methods Altogether 200 primiparas meeting inclusion criteria, admitted in Xuancheng Central Hospital from January to December in 2015 and treated with epidural labor analgesia were selected and divided into intermittent group (n=100) and continuous group (n=100) based on different administration methods.Patients in the intermittent group were given 10ml of drug at one time, and drug was administered to the continuous group at constant speed of 10ml/h.Dose of drug was 8mg of 0.08% ropivacaine plus 4μg of 0.4μg/ml sulfentanyl.Fever cases, level of sensory block, interleukin-6, tympanic membrane temperature before analgesia and at 60 min, 120 min, 180 min, 240 min, 300 min after analgesia, at childbirth and 60 min after delivery in two groups were recorded.Maternal and neonatal birth time, analgesic time, neonatal weight, Apgar score and other indicators of epidural block in two groups were compared.Results There was no significant difference between two groups in intrapartum fever and sensory block at all periods (F value was 1.52 and 0.79, respectively, both P>0.05).Compared with before analgesia, tympanic membrane temperature at 240 min and 300 min after analgesia, at childbirth and 60 min after delivery in two groups was increased and difference had statistical significance (F=3.48, P<0.05).Level of interleukin-6 at all periods after analgesia increased significantly in two groups compared with before analgesia , and increase in the continuous group was more obvious (F value was 3.42 and 4.00, respectively, both P<0.05).VAS scores in the continuous group at 180 and 240 min after analgesia were higher than those in the intermittent group (F=3.23, P<0.05).Dosage of ropivacaine and sulfentanyl used in the continuous group was higher than that in the intermittent group and difference was statistically significant (t value was 4.63 and 6.16, respectively, both P<0.05).Conclusion There is no significant difference in intrapartum fever cases caused by intermittent or continuous administration of drugs during epidural labor analgesia.Rising of body temperature may be related to interleukin-6.Intermittent administration has lower dosage and better analgesic effect.
展开▼
