不同体位硬膜外分娩镇痛低血压发生率及新生儿Apgar评分比较

蔡军

不同体位硬膜外分娩镇痛低血压发生率及新生儿Apgar评分比较

蔡军

To compare the puerperal’s incidence of hypotension and neonate Apgar in different position after epidural labor analgesia

摘要

摘要: 目的：比较0.1%罗哌卡因硬膜外分娩镇痛后仰卧-侧卧结合体位和单纯侧卧位对产妇低血压发生率、镇痛效果及新生儿Apgar评分的影响。方法：选择ASA分级Ⅰ~Ⅱ级，年龄20~32岁初产妇60例，随机分为仰卧-侧卧位组（A组），侧卧位组（B组），每组30例，镇痛前（T0）监测收缩压（SBP）、平均动脉压（MAP）、VAS评分和胎心率,行L2、3间隙硬膜外穿刺、置管，A组镇痛后采取仰卧10分钟再侧卧结合体位；B组镇痛后采取侧卧位。而后0.1%罗哌卡因复合2ug/ml芬太尼微量输注泵8-10ml/小时速度维持。分别观察两组产妇镇痛后10分钟（T1）、30分钟（T2）SBP、MAP、VAS评分及镇痛后胎儿心率和新生儿出生后Apgar评分的情况。结果：两组产妇镇痛后T1、T2时SBP、MAP较T0明显降低（P<0.05）;T1时A组SBP、MAP、SBP波动幅度、MAP波动率均低于B组，有显著差异（P<0.05）； T1时VAS评分A组明显低于B组，有显著差异（P<0.05）；而两组仰卧位低血压发生率、胎儿心率和新生儿Apgar评分相比无显著差异（P>0.05）.结论：硬膜外分娩镇痛后产妇采取仰卧-侧卧结合体位，能明显减少血压波动，且在更短时间达到满意的镇痛效果，提升产妇满意度和信任感。

Abstract: Objective：To compare the puerperal’s incidence of hypotension，analgesia effect and neonate Apgar in backlying-lateral position and lateral decubitus after 0.1% ropivacaine epidural labor analgesia . Methods:20-32 years old puerperal (ASA Ⅰ~Ⅱ ) average devide into 2 groups, backlying-lateral position( group A ) and lateral position(group B).After L2-3 epidural labor analgesia , group A keep backlying position 10 minites then change to lateral position while group B always take lateral position, both groups monitoring SBP、MAP、VAS in 10 minites(T1)and 30 minites(T2) , fetus heart rates and neonate Apgar scores. Results： SBP、MAP degrade obviously(P<0.05) after analgesia in both groups comparing with ante-analgesia(T0), SBP、MAP、SBP fluctuate extent and MAP fluctuate rate, VAS in group A is lower than group B（P<0.05）on T1 time;while there have no diferencet in hypotension incidence, neonate Apgar between group A and group B（P>0.05）. conclusion: comparing with lateral decubitus, backlying-lateral position could decrease blood pressure fluctuation and gain more better analgesia effect rapidly.

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