【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ASAⅠ～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、L₃间隙硬膜外穿刺、置管,A组镇痛后采取仰卧10 min再侧卧结合体位;B组镇痛后采取侧卧位。而后以0.1%罗哌卡因复合2 mg/L芬太尼微量输注泵以8～10 ml/h速度维持。分别观察2组产妇镇痛后10 min（T₁）、30 min（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 2组产妇镇痛后T₁、T₂时SBP、MAP较T₀时明显降低（P<0.05）;T₁时A组SBP、MAP、SBP波动幅度,MAP波动率均低于B组,差异有统计学意义（P<0.05）;T₁时VAS评分A组明显低于B组,差异有统计学意义（P <0.05）;而2组仰卧位低血压发生率、胎儿心率和新生儿Apgar评分相比差异无统计学意义（P>0.05）;A组一、二产程满意度明显高于B组（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。更多还原

【Abstract】 Objective To compare the hypotension incidence,analgesic effects and Apgar scores after epidural labor analgesia using 0.1% ropivacaine in the supine-lateral positions and lateral position alone.Methods A total of 60primiparous aging 20-32s old,ASA Ⅰ-Ⅱ were randomly divided into two groups（n=30）:a supine-lateral position group（Group A） and a lateral position（Group B）.Their systolic blood pressure（SBP）,mean arterial pressure（MAP）,VAS scores and fetal heart rates were monitored before anesthesia（T₀）.During epidural labor analgesia at the L₂-L₃ interspace,Group A kept in the supine position for 10 min followed by the lateral position,while Group B remained in the lateral position.Both groups were administered with a combination of 0.1 % ropivacaine and 2 mg/L fentanyl at 8-10 ml/h for maintenance of anesthesia.Then,SBP,MAP,VAS scores,fetal heart rates and Apgar scores were detected 10 min and 30 min after anesthesia（T₁and T₂）.Results Both groups showed remarkable decreases in SBP and MAP at T₁and T₂,compared with those at T₀（P<0.05）.Group A presented reduced SBP and MAP,SBP fluctuation,MAP fluctuation rate,and VAS scores at T₁,compared with Group B（P <0.05）.Meanwhile,no difference was found as to hypotension incidence,fetal heart rates and Apgar scores between the two groups（P>0.05）.Conclusions Epidural labor analgesia in the supine-lateral positions can remarkable reduce blood pressure changes and achieve anesthetic satisfaction in a short time,which is helpful to enhance patient satisfaction and trust.更多还原