可 焱，鄭 凌

(陜西省西安市第四醫(yī)院麻醉科，陜西 西安 710004)

妊娠期高血壓疾病患者無(wú)痛分娩中麻醉應(yīng)用效果比較

可 焱，鄭 凌

(陜西省西安市第四醫(yī)院麻醉科，陜西 西安 710004)

目的探討低濃度舒芬太尼復(fù)合0.1%羅哌卡因腰硬聯(lián)合麻醉(CSEA)+自控硬膜外鎮(zhèn)痛泵(PCEA)在妊娠期高血壓疾病患者無(wú)痛分娩中的應(yīng)用效果。方法選擇陜西省西安市第四醫(yī)院2016年6月至2017年2月119例妊娠期高血壓疾病產(chǎn)婦隨機(jī)分為3組，先椎管內(nèi)單純預(yù)注不同濃度的舒芬太尼，A組37例0μg/mL、B組42例0.4μg/mL、C組40例0.6μg/mL，后用舒芬太尼復(fù)合0.1%羅哌卡因行PCEA。比較三組鎮(zhèn)痛前、鎮(zhèn)痛后10min、20min、30min視覺模擬評(píng)分(VAS)評(píng)分，第一、二產(chǎn)程的時(shí)間及血壓變化，產(chǎn)后1h內(nèi)出血量，剖宮產(chǎn)率，先兆子癇和不良反應(yīng)發(fā)生率及新生兒Apgar評(píng)分。結(jié)果三組鎮(zhèn)痛后各時(shí)間點(diǎn)VAS評(píng)分比較差異均有統(tǒng)計(jì)學(xué)意義(F值分別為6.138、10.142、3.341、5.883，均Plt;0.05)，B組鎮(zhèn)痛后10min、20minVAS評(píng)分與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為3.525、9.418，均Plt;0.05)，鎮(zhèn)痛后30min、宮口開全與A組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(Pgt;0.05)；C組鎮(zhèn)痛后10min、20min、30min VAS評(píng)分與A組差異有統(tǒng)計(jì)學(xué)意義(t值分別為5.376、13.650、2.365，均Plt;0.05)，宮口開全與A組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(Pgt;0.05)；B組與C組鎮(zhèn)痛后各時(shí)間點(diǎn)比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(均Pgt;0.05)。三組第一產(chǎn)程收縮壓、舒張壓比較差異均有統(tǒng)計(jì)學(xué)意義(F分別為7.119、6.202，均Plt;0.05)，B、C組與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為12.989、7.536；13.650、6.281，均Plt;0.05)，B組與C組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(均Pgt;0.05)；三組第二產(chǎn)程收縮壓、舒張壓比較差異均有統(tǒng)計(jì)學(xué)意義(F分別為6.703、5.113，均Plt;0.05)，B、C組與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為6.938、8.627；7.489、7.343，均Plt;0.05)，B組與C組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為0.115、0.042，均Pgt;0.05)。三組第一、二產(chǎn)程時(shí)間、產(chǎn)后1h內(nèi)出血量比較差異均有統(tǒng)計(jì)學(xué)意義(F值分別為2.572、4.589、2.664，均Plt;0.05)，且剖宮產(chǎn)率比較差異有統(tǒng)計(jì)學(xué)意義(χ2=8.438，Plt;0.05)，A組均最高。C組惡心嘔吐發(fā)生率均明顯高于A、B組(χ2值分別為7.112、5.319，均Plt;0.05)，瘙癢發(fā)生率明顯高于A、B組(χ2值分別為3.902、6.794，均Plt;0.05)。結(jié)論妊娠期高血壓疾病患者分娩鎮(zhèn)痛以0.1%羅哌卡因復(fù)合舒芬太尼0.4μg/mL為最佳，不僅鎮(zhèn)痛效果好，而且可有效維持血壓平穩(wěn)、縮短產(chǎn)程進(jìn)展，降低剖宮產(chǎn)率，減少不良反應(yīng)。

舒芬太尼；羅哌卡因；腰硬聯(lián)合麻醉；自控硬膜外鎮(zhèn)痛泵；妊娠期高血壓疾病

蛛網(wǎng)膜下腔阻滯(腰麻)+硬脊膜外腔阻滯(聯(lián)合麻醉)(combined spinal and epidural anesthesia，CSEA)是目前比較推崇的一種分娩鎮(zhèn)痛方法，既具有腰麻起效迅速、神經(jīng)阻滯完善的優(yōu)點(diǎn)，又具有聯(lián)合麻醉可持續(xù)給藥鎮(zhèn)痛的優(yōu)點(diǎn)[1]。羅哌卡因是常用的局麻藥物，但高濃度羅哌卡因的不良反應(yīng)較多，0.1%羅哌卡因可大大減少不良反應(yīng)，然而鎮(zhèn)痛效果降低，產(chǎn)婦往往在第二產(chǎn)程有加藥的訴求[2]。舒芬太尼是一種新型強(qiáng)效的阿片類鎮(zhèn)痛藥，目前鞘內(nèi)注射舒芬太尼已被成功應(yīng)用于無(wú)痛分娩。0.1%羅哌卡因復(fù)合舒芬太尼已成為無(wú)痛分娩的優(yōu)選。妊娠期高血壓疾病屬于產(chǎn)科嚴(yán)重并發(fā)癥，中、重度妊娠期高血壓疾病患者在進(jìn)入產(chǎn)程活躍期后容易出現(xiàn)大幅度的血壓波動(dòng)，為保險(xiǎn)起見常選擇剖宮產(chǎn)終止妊娠，但部分學(xué)者指出妊娠期高血壓疾病患者通過自控硬膜外鎮(zhèn)痛泵(patient-controlled epidural analgesic pump，PCEA)手段可縮短產(chǎn)程，無(wú)需增加剖宮產(chǎn)的負(fù)擔(dān)[3]。為此，本研究探討了舒芬太尼伍用羅哌卡因CSEA+PCEA對(duì)妊娠期高血壓疾病患者的影響及其量效關(guān)系，為妊娠期高血壓疾病終止妊娠的方式提供參考，報(bào)告如下。

1資料和方法

1.1一般資料

選擇陜西省西安市第四醫(yī)院2016年6月至2017年2月119例妊娠期高血壓疾病產(chǎn)婦，入選標(biāo)準(zhǔn)：①單胎、頭位、足月初產(chǎn)婦；②美國(guó)麻醉醫(yī)師協(xié)會(huì)(American Society of anesthesiologists,ASA)Ⅰ～Ⅱ級(jí)；③無(wú)產(chǎn)科高危因素；④無(wú)麻醉禁忌證；⑤無(wú)肝、腎、電解質(zhì)異常；⑥既往無(wú)鎮(zhèn)痛、催眠藥應(yīng)用史；⑦簽署知情同意書。排除明顯頭盆不稱、產(chǎn)前出現(xiàn)子癇者。隨機(jī)分為三組，A組37例，年齡25.4±4.1歲，體重66.2±17.3kg，孕周38.2±0.5周，輕度6例，中度22例，重度9例；B組42例，年齡26.9±5.5歲，體重65.0±14.2kg，孕周38.0±0.7周，輕度8例，中度25例，重度9例；C組40例，年齡26.1±5.2歲，體重67.0±16.2kg，孕周38.0±0.9周，輕度8例，中度26例，重度6例；三組孕婦年齡、體重、孕周及病情程度差異均無(wú)統(tǒng)計(jì)學(xué)意義(均Pgt;0.05)。

1.2方法

入待產(chǎn)室后常規(guī)開放上肢靜脈，連接監(jiān)護(hù)儀，當(dāng)宮口開大3cm時(shí)均行腰硬聯(lián)合麻醉，于L3～4椎間隙硬膜外穿刺刺入蛛網(wǎng)膜下腔，先椎管內(nèi)單純預(yù)注不同濃度的舒芬太尼(注冊(cè)證號(hào)：H20100124，2010-02-11)，A組0μgL，B組0.4μg/mL，C組0.6μg/mL。產(chǎn)婦改平臥位約30min后連接硬膜外自控鎮(zhèn)痛泵，輸注0.1%羅哌卡因(注冊(cè)證號(hào)：H20100106，2010-02-11)100mL復(fù)合舒芬太尼40μg混合液，輸注速率4mL/h，鎖定時(shí)間10min。產(chǎn)婦在分娩過程中可根據(jù)疼痛行自控鎮(zhèn)痛，控制麻醉阻滯平面在T10以下，宮口開全時(shí)停止給藥。

1.3觀察指標(biāo)

連續(xù)監(jiān)測(cè)產(chǎn)婦的血壓、呼吸、心率、脈搏血氧飽和度及胎心率，根據(jù)產(chǎn)程進(jìn)展觀察宮頸口大小變化，記錄第一、二產(chǎn)程時(shí)間，產(chǎn)后1h內(nèi)出血量，剖宮產(chǎn)例數(shù)，先兆子癇發(fā)生例數(shù)、不良反應(yīng)及新生兒1min Apgar評(píng)分。分別在鎮(zhèn)痛前、鎮(zhèn)痛后10min、20min、30min采用視覺模擬評(píng)分(visual simulation score，VAS)評(píng)估疼痛程度，0～2分無(wú)明顯疼痛，2～4分輕度疼痛，4～6分中度疼痛，6～10分重度疼痛，10分劇痛。

1.4 統(tǒng)計(jì)學(xué)方法

2結(jié)果

2.1組間各時(shí)點(diǎn)VAS評(píng)分比較

三組鎮(zhèn)痛前VAS評(píng)分比較差異無(wú)統(tǒng)計(jì)學(xué)意義(F=0.371，Pgt;0.05)。鎮(zhèn)痛后各時(shí)間點(diǎn)VAS評(píng)分較鎮(zhèn)痛前差異均有統(tǒng)計(jì)學(xué)意義(均Plt;0.05)：A組鎮(zhèn)痛后各時(shí)間點(diǎn)與鎮(zhèn)痛前比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為12.494、17.236、28.131、28.937，均Plt;0.05)；B組鎮(zhèn)痛后各時(shí)間點(diǎn)與鎮(zhèn)痛前比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為10.081、19.623、23.375、24.496，均Plt;0.05)；C組鎮(zhèn)痛后各時(shí)間點(diǎn)與鎮(zhèn)痛前比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為10.933、19.623、21.403、20.669，均Plt;0.05)；B組鎮(zhèn)痛后10min、20min與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為3.525、9.418，均Plt;0.05)，鎮(zhèn)痛后30min、宮口開全與A組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為0.417、0.773，均Pgt;0.05)；C組鎮(zhèn)痛后10min、20min、30min與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為5.376、13.650、2.365，均Plt;0.05)，宮口開全與A組比較無(wú)統(tǒng)計(jì)學(xué)意義(t=0.946，Pgt;0.05)；B組與C組鎮(zhèn)痛后各時(shí)間點(diǎn)比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為0.176、0.942、1.103、0.663、0.274，均Pgt;0.05)，見表1。

表1 組間各時(shí)點(diǎn)VAS評(píng)分比較(分,

注：*與本組鎮(zhèn)痛前比較，Plt;0.05；#與A組同時(shí)點(diǎn)比較，Plt;0.05。

2.2組間血壓變化比較

三組第一產(chǎn)程收縮壓、舒張壓比較差異均有統(tǒng)計(jì)學(xué)意義(均Plt;0.05)，B、C組與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為12.989、7.536；13.650、6.281，均Plt;0.05)，B組與C組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為0.048、0.057，均Pgt;0.05)；三組第二產(chǎn)程收縮壓、舒張壓比較差異均有統(tǒng)計(jì)學(xué)意義(均Plt;0.05)，B、C組與A組比較差異均有統(tǒng)計(jì)學(xué)意義(t值分別為6.938、8.627；7.489、7.343，均Plt;0.05)，B組與C組比較差異均無(wú)統(tǒng)計(jì)學(xué)意義(t值分別為0.115、0.042，均Pgt;0.05)，見表2。

2.3組間產(chǎn)程時(shí)間、產(chǎn)后1h內(nèi)出血量、剖宮產(chǎn)率及Apgar評(píng)分比較

三組第一、二產(chǎn)程，產(chǎn)后1h內(nèi)出血量差異均有統(tǒng)計(jì)學(xué)意義(均Plt;0.05)，且剖宮產(chǎn)率差異有統(tǒng)計(jì)學(xué)意義(Plt;0.05)，A組均最高，見表3。

表2 組間血壓變化比較

注：*與A組比較，Plt;0.05。

表3 組間產(chǎn)程時(shí)間、產(chǎn)后1h內(nèi)出血量、剖宮產(chǎn)率及APgar評(píng)分比較

注：*與A組比較，Plt;0.05。

2.4組間先兆子癇及不良反應(yīng)發(fā)生率比較

C組惡心嘔吐、瘙癢發(fā)生率均明顯高于A、B組(χ2值分別為7.112、5.319;3.902、6.794，均Plt;0.05)，見表4。

表4 組間先兆子癇及不良反應(yīng)發(fā)生率比較[n(%)]

注：*與C組比較，Plt;0.05。

3討論

羅哌卡因?yàn)樾滦王０奉惥致樗?，具有良好的分娩?zhèn)痛效果，0.1%羅哌卡因即可產(chǎn)生運(yùn)動(dòng)感覺神經(jīng)阻滯分離，在阻斷產(chǎn)婦對(duì)疼痛感知的同時(shí)并不會(huì)影響產(chǎn)婦在第二產(chǎn)程的屏氣用力及產(chǎn)后子宮收縮，被認(rèn)為是“可行走的分娩鎮(zhèn)痛”的藥物[4]。舒芬太尼為新型μ受體激動(dòng)劑，μ受體結(jié)合性能與激動(dòng)作用及安全范圍均優(yōu)于芬太尼，椎管內(nèi)注入后起效更快、效應(yīng)更強(qiáng)、持續(xù)時(shí)間更長(zhǎng)，同時(shí)血藥濃度低，不會(huì)對(duì)新生兒產(chǎn)生明顯的不良影響[5-6]。

3.1從鎮(zhèn)痛效果與不良反應(yīng)考慮舒芬太尼的合適濃度

本研究通過椎管內(nèi)單純注入不同濃度的舒芬太尼，再用舒芬太尼復(fù)合0.1%羅哌卡因行PCEA，結(jié)果發(fā)現(xiàn)，與單純0.1%羅哌卡因鎮(zhèn)痛相比，復(fù)合舒芬太尼的鎮(zhèn)痛效果更好(Plt;0.05)，各組均未出現(xiàn)運(yùn)動(dòng)神經(jīng)阻滯現(xiàn)象。有研究證明，阿片類鎮(zhèn)痛藥復(fù)合硬脊膜外局麻藥在起到最小運(yùn)動(dòng)神經(jīng)阻滯作用的同時(shí)，可減少局麻藥用量[7-8]。但與低濃度舒芬太尼相比，高濃度舒芬太尼的鎮(zhèn)痛效果并無(wú)明顯增強(qiáng)(Pgt;0.05)，反而惡心嘔吐、瘙癢的發(fā)生率明顯增高(Plt;0.05)，提示舒芬太尼配伍羅哌卡因可有效提高鎮(zhèn)痛作用，但有封頂現(xiàn)象，舒芬太尼0.4μg/mL用于鞘內(nèi)分娩鎮(zhèn)痛是安全有效的，這與有些研究結(jié)果有一致性。

3.2從血壓變化考慮舒芬太尼的合適濃度

妊娠期高血壓疾病產(chǎn)婦在第二產(chǎn)程由于屏氣用力造成血壓大幅波動(dòng)易導(dǎo)致子癇的發(fā)生，因而控制血壓穩(wěn)定是預(yù)防重度妊娠期高血壓疾病患者出現(xiàn)子癇的重要策略。研究表明，PCEA有助于降低妊娠期高血壓疾病患者的血壓水平[9-10]。本研究發(fā)現(xiàn)，妊娠期高血壓疾病產(chǎn)婦采用單純0.1%羅哌卡因鎮(zhèn)痛第一、二產(chǎn)程的血壓水平均明顯高于羅哌卡因復(fù)合舒芬太尼鎮(zhèn)痛(Plt;0.05)，且出現(xiàn)3例先兆子癇。說(shuō)明羅哌卡因復(fù)合舒芬太尼的鎮(zhèn)痛更完善，產(chǎn)婦在分娩過程中的痛苦減輕，精神情緒得到緩解，有利于維持血壓平穩(wěn)，從而降低了先兆子癇發(fā)生的危險(xiǎn)，而舒芬太尼0.4μg/mL與0.6μg/mL對(duì)血壓的影響無(wú)明顯差異。

3.3從產(chǎn)程及母嬰結(jié)局考慮舒芬太尼的合適濃度

目前對(duì)中重度妊娠期高血壓疾病患者終止妊娠的方式仍存在不統(tǒng)一意見，很多學(xué)者認(rèn)為需行剖宮產(chǎn)術(shù)，但另外有學(xué)者認(rèn)為通過PCEA手段可促進(jìn)產(chǎn)程進(jìn)展，陰道分娩仍可行[11]。本研究發(fā)現(xiàn)，0.1%羅哌卡因復(fù)合舒芬太尼用于妊娠期高血壓疾病的無(wú)痛分娩可明顯縮短第一、二產(chǎn)程時(shí)間，降低剖宮產(chǎn)率，增加陰道分娩率，且對(duì)新生兒Apgar評(píng)分無(wú)明顯影響，是安全可行的，而舒芬太尼0.4μg/mL的產(chǎn)程及出血量較舒芬太尼0.6μg/mL縮短或減少，但尚未達(dá)到統(tǒng)計(jì)學(xué)意義。

綜上所述，羅哌卡因復(fù)合舒芬太尼應(yīng)用于妊娠期高血壓疾病的無(wú)痛分娩的效果優(yōu)于單純羅哌卡因，并可有效維持血壓平穩(wěn)、縮短產(chǎn)程進(jìn)展，降低剖宮產(chǎn)率，且低濃度舒芬太尼的安全性進(jìn)一步提高。

[1]常永健, 熊敏. 硬膜外阻滯麻醉技術(shù)應(yīng)用于無(wú)痛分娩安全有效[J]. 基因組學(xué)與應(yīng)用生物學(xué), 2017,36(4):1418-1421.

[2]楊世輝, 黃希照, 胡祖榮,等. 0.1%羅哌卡因復(fù)合舒芬太尼用于無(wú)痛分娩對(duì)母嬰一氧化氮及皮質(zhì)醇的影響[J]. 廣東醫(yī)學(xué), 2012, 33(6):851-853.

[3]黃智明, 張翠然, 許陪陪. 硬膜外分娩鎮(zhèn)痛對(duì)妊娠期高血壓患者自然分娩血壓和產(chǎn)程的影響[J]. 中國(guó)藥業(yè), 2015, 24(24):55-56.

[4]Watt D G, Horgan P G, McMillan D C. Routine clinical markers of the magnitude of the systemic inflammatory response after elective operation: a systematic review[J]. Surgery,2015, 157(2):362-380.

[5]Encalada M A, Rehecho S, Ansorena D,etal. Antiproliferative effect of phenylethanoid glycosides from Verbena officinalis L. on Colon Cancer Cell Lines[J]. LWT Food Sci Technol, 2015, 63(2):1016-1022.

[6]Li H, Li Y, He R. Sparing effects of sufentanil on epidural ropivacaine in elderly patients undergoing transurethral resection of prostate surgery[J]. Yonsei Med J, 2015, 56(3):832-837.

[7]付衛(wèi)星, 康佳麗, 熊美麗,等. 羅哌卡因聯(lián)合舒芬太尼分娩鎮(zhèn)痛對(duì)嬰兒生長(zhǎng)發(fā)育的影響[J]. 實(shí)用醫(yī)學(xué)雜志, 2012, 28(7):1179-1181.

[8]楊裕蓮.不同濃度羅哌卡因復(fù)合芬太尼用于分娩鎮(zhèn)痛的臨床觀察[J]. 醫(yī)藥論壇雜志, 2012, 33(10):109-110.

[9]Wang X, Xu S, Qin X,etal. Comparison between the use of ropivacaine alone and ropivacaine with sufentanil in epidural labor analgesia[J]. Medicine (Baltimore), 2015, 94(43):e1882.

[10]Xu G H, Gao M, Sheng Q Y,etal. Opioid receptor A118G polymorphism does not affect the consumption of sufentanil and ropivacaine by patient-controlled epidural analgesia after cesarean section[J]. Ther Drug Monit, 2015, 37(1):53-57.

[11]Everaert N, Coppens M, Vlerick P,etal. Combined spinal epidural analgesia for labor using sufentanil epidurally versus intrathecally: a retrospective study on the influence on fetal heart trace[J]. J Perinat Med, 2015, 43(4):481-484.

[專業(yè)責(zé)任編輯： 陳 寧]

Effectcomparisonofanesthesiamethodsusedinpainlessdeliveryofpatientswithpregnancyinducedhypertension

KE Yan, ZHENG Ling

(DepartmentofAnesthesiology,FourthHospitalofXi’an,ShaanxiXi’an710004,China)

ObjectiveTo investigate the effect of combined spinal epidural anesthesia (CSEA) with low dose of sufentanil combined with 0.1% ropivacaine and patient-controlled epidural analgesia (PCEA) pump in painless delivery of patients with pregnancy induced hypertension.MethodsAltogether 119 women with pregnancy induced hypertension were enrolled and randomly divided into 3 groups. Patients were firstly injected with different concentrations of sufentanil in spinal canal, with 0ug/ml for 37 cases in group A, 0.4ug/ml for 42 cases in group B and 0.6ug/ml for 40 cases in group C. Then PCEA with sufentanil combined with 0.1% ropivacaine was conducted. Three groups were compared in terms of visual analogue scale (VAS) score before analgesia and at 10min, 20min and 30min after analgesia, duration of first and second stages of labor and blood pressure change, bleeding volume at 1h after delivery, cesarean section rate, incidence of preeclampsia and adverse reactions, and neonatal Apgar score.ResultsDifference in VAS score at each time point after analgesia in three groups was statistically significant (Fvalue was 6.138, 10.142, 3.341 and 5.883, respectively allPlt;0.05). VAS score at 10min and 20min after analgesia in group B had statistically significant difference compared with that in group A (tvalue was 3.525 and 9.418, respectively, bothPlt;0.05), and that at 30min after analgesia and at uterus open to full extent in group B was not significantly different from that in group A (tvalue was 0.417 and 0.773, respectively, bothPgt;0.05). VAS score at 10min, 20min and 30min after analgesia in group C was significantly different compared with that in group A (tvalue was 5.376, 13.650 and 2.365, respectively, allPlt;0.05), while that at uterus open to full extent in group C was not significantly different compared with that in group A (t=0.946,Pgt;0.05). There was no significant difference between group B and group C at each time point after analgesia (tvalue was 0.176, 0.942, 1.103, 0.663 and 0.274, respectively, allPgt;0.05). Difference in systolic blood pressure and diastolic blood pressure at first stage of labor among three groups was statistically significant (Fvalue was 7.119 and 6.202, respectively, bothPlt;0.05), and systolic blood pressure and diastolic blood pressure at first stage of labor in group B and group C were significantly different from those in group A (tvalue was 12.989, 7.536, 13.650 and 6.281, respectively, allPlt;0.05). There was no statistically significant difference in systolic blood pressure and diastolic blood pressure at first stage of labor between group B and group C (tvalue was 0.048 and 0.057, respectively, bothPgt;0.05). The systolic blood pressure and diastolic blood pressure in three groups at second stage were significantly different (Fvalue was 6.703 and 5.113, respectively, bothPlt;0.05), and those in group B and group C were significantly different compared with those in group A (tvalue was 6.938, 8.627, 7.489 and 7.343, respectively, allPlt;0.05). There was no statistically significant difference in systolic blood pressure and diastolic blood pressure at second stage of labor between group B and group C (tvalue was 0.115 and 0.042, respectively, bothPgt;0.05). There were significant differences in durations of first and second stage and bleeding volume at 1h after delivery among three groups (Fvalue was 2.572, 4.589 and 2.664, respectively, allPlt;0.05), and the difference in cesarean section rate among three groups was statistically significant (χ2=8.438,Plt;0.05) with highest rate in group A. Incidence of nausea and vomiting in group C was significantly higher than that in group A and B (χ2value was 7.112 and 5.319, respectively, bothPlt;0.05), and incidence of pruritus in group C was also significantly higher than other two groups (χ2value was 3.902 and 6.794, respectively, bothPlt;0.05).ConclusionEffect of 0.1% ropivacaine combined with 0.4ug/ml sufentanil is best in labor analgesia for patients with pregnancy induced hypertension. It dose not only have a good analgesic effect, but also effectively maintains a stable blood pressure, shortens birth process and reduce rate of cesarean section and adverse reactions.

sufentanil; ropivacaine; combined spinal epidural anesthesia (CSEA); patient-controlled epidural analgesia (PCEA); pregnancy induced hypertension

10.3969/j.issn.1673-5293.2017.11.047

R714.2

A

1673-5293(2017)11-1454-04

2017-06-27

可 焱(1974—)，女，副主任醫(yī)師，主要從事小兒麻醉及危重癥麻醉工作。

鄭 凌，副主任醫(yī)師。