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Received:June 27, 2024 Published Online:December 21, 2024
Received:June 27, 2024 Published Online:December 21, 2024
中文摘要: 目的 评价利多卡因在缓解肥胖初产妇硬膜外分娩镇痛中爆发痛的效果及对母婴的影响。方法 选择2022年10月至2023年12月在南京市妇幼保健院进行硬膜外分娩镇痛的120例肥胖 [身体质量指数（BMI） 35.0～45 kg/m2］，且在第一产程中发生爆发痛的初产妇。所有患者随机分为两组，每组60例，试验组接受硬膜外推注1.0%利多卡因6 mL，对照组接受硬膜外推注0.15%罗哌卡因6 mL。记录视觉模拟评分（VAS）下降到3分或以下的时间、首次爆发痛发生时的宫口扩张值、产程中追加药物的次数、不同时间点VAS评分、分娩相关情况（产程时间、缩宫素使用率、分娩后2 h出血量、分娩方式）及分娩镇痛期间不良反应的发生情况。结果 与对照组比较，试验组产妇的VAS疼痛评分下降到3分或以下的时间显著缩短 [7（6，7）min vs 16（16，17）min， Z=52.624， P＜0.01］。两组首次爆发痛发生时的宫口扩张值和产程中追加药物的次数差异无统计学意义（P＞0.05）。给药后的5 min（T1）、10 min（T2）、15 min（T3）时，试验组的VAS评分低于对照组（P＜0.05）。两组产妇的产程时间、缩宫素使用率、分娩后2 h出血量、分娩方式以及镇痛期间不良反应的发生率差异无统计学意义（P＞0.05）。结论 硬膜外给予6 mL 1.0%利多卡因或6 mL 0.15%罗哌卡因均能有效抑制肥胖产妇硬膜外分娩镇痛中的爆发痛，并改善母婴转归。且利多卡因的起效时间更短，VAS评分下降更迅速。
Abstract:Objective To evaluate the clinical efficacy of lidocaine in alleviating breakthrough pain during labor in obese primiparas and its effect on maternal and infant outcomes. Methods A total of 120 obese primiparas (body mass index being 35 to 45 kg/m2) underwent epidural analgesia during delivery at Nanjing Women and Children’s Healthcare Hospital from October 2022 to December 2023 were selected and all primiparas experienced breakthrough pain during the first stage of labor. All patients were randomly divided into two groups, with 60 cases in each group. The experimental group received 6 mL of 1.0% lidocaine administered by epidural injection when breakthrough pain occurred (VAS score≥4), while the control group received 6 mL of 0.15% ropivacaine by epidural injection. The following parameters were recorded: time for VAS scores decreasing to 3 or below, cervical dilation at the onset of the first breakthrough pain, number of additional drug administrations during labor, VAS scores at various time points, delivery-related outcomes (duration of labor, use rate of oxytocin, blood loss within 2 hours after delivery, mode of delivery), and adverse events during analgesia. Results Compared with the control group, the experimental group had a shorter time for the VAS score decreasing to 3 or below [7(6,7) min vs 16(16,17) min, Z=52.624, P＜0.01]. There was no statistically significant difference in the cervical dilation at the onset of the first breakthrough pain and number of additional drug administrations during labor (P＞0.05). At 5 min (T1), 10 min (T2), and 15 min (T3) after administration, the VAS scores of the experimental group were lower than those of the control group (P＜0.05). There was no statistically significant difference in the duration of labor, usage rate of oxytocin, blood loss within 2 hours after delivery, mode of delivery, and adverse events during analgesia between the two groups (P＞0.05). Conclusion Both 6 mL of 1.0% lidocaine and 6 mL of 0.15% ropivacaine administered by epidural injection can effectively suppress breakthrough pain in obese parturient during epidural labor analgesia, and improve maternal and neonatal outcomes. And lidocaine demonstrates a shorter onset time, and a faster decrease in VAS score.
keywords: Labor analgesia, epidural Breakthrough pain Lidocaine Ropivacaine Obese primiparas Maternal and infant outcomes
文章编号： 中图分类号：R614.4+2 文献标志码：A
基金项目:江苏省科技厅重点研发计划（社会发展）面上项目（BE2021615）
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