标题：罗哌卡因复合舒芬太尼分娩镇痛对产妇产间发热的影响

      作者：张士民，吴华彬    上海市金山区亭林医院麻醉科，上海 201505

      卷次： 2020年31卷20期

      【摘要】 目的 观察罗哌卡因复合舒芬太尼分娩镇痛对产妇产间发热的影响。方法 2019年1~12月期间，上海市金山区亭林医院收治的180例产妇根据产妇意愿选择镇痛分娩及正常分娩，其中120例镇痛分娩者采用随机数表法分为A组和B组各60例，A组给予0.065%罗哌卡因复合舒芬太尼0.03 μg/mL镇痛分娩，B组给予0.13%罗哌卡因复合舒芬太尼0.03 μg/mL。60例选择未镇痛分娩者纳入C组。比较三组产妇产间发热情况、白细胞介素-1β (IL-1β)、白细胞介素-6 (IL-6)、肿瘤坏死因子α (TNF-α)等致热因子浓度变化、运动阻滞效果、镇痛效果及新生儿Apgar评分。结果 B组、A组和C组产妇发热率分别为 30.0%、20.0%和 5.0%，B组产妇发热率明显高于A组和C组，A组明显高于C组，差异均有统计学意义(P<0.05)；三组新生儿 1 min Apgar评分、5 min Apgar评分比较差异均无统计学意义(P>0.05)；与本组镇痛前比较，A组、B组产妇镇痛后 4 h的鼓膜温度均明显升高，差异有统计学意义(P<0.05)；镇痛后 4 h A组产妇鼓膜温度明显高于B组，差异有统计学意义(P<0.05)，而其余时间点两组产妇的鼓膜温度比较差异均无统计学意义(P>0.05)；与本组镇痛前比较，A组、B组胎儿娩出即刻的产妇血清 IL-1β、IL-6、TNF-α水平均明显升高，差异均有统计学意义(P<0.05)；B组胎儿娩出即刻产妇血清 IL-1β、IL-6、TNF-α水平高于A组，差异均有统计学意义(P<0.05)；B组产妇镇痛后 0.5 h、胎儿娩出即刻的改良Bromage评分明显低于A组，差异均有显著统计学意义(P<0.01)；B组产妇分娩镇痛后 10 min、30 min、宫口全开后VAS评分明显低于A组，差异均有统计学意义(P<0.01或<0.05)。结论 高浓度罗哌卡因复合舒芬太尼分娩镇痛具有良好的镇痛效果，但高浓度分娩镇痛可增加产妇产间发热率，分娩期间发热与致热因子水平升高有关，临床需根据产妇病情合理选择麻醉方案。
      【关键词】 罗哌卡因；舒芬太尼；分娩镇痛；产间发热；致热因子
      【中图分类号】 R714.3 【文献标识码】 A 【文章编号】 1003—6350（2020）20—2647—04

Effect of ropivacaine combined with sufentanil for labor analgesia on maternal fever during delivery.
ZHANGShi-min, WU Hua-bin. Department of Anesthesia, Tinglin Hospital of Jinshan District of Shanghai, Shanghai 201505,CHINA
【Abstract】 Objective To observe the effect of ropivacaine combined with sufentanil for labor analgesia on ma-ternal fever during delivery. Methods A total of 180 pregnant women admitted to Tinglin Hospital of Jinshan Districtof Shanghai, from January to December 2019 were selected for analgesia delivery and normal delivery according to theirdesires. The 120 patients receiving analgesia delivery were divided into group A (60 cases), group B (60 cases) by ran-dom number table method, which was given 0.065% ropivacaine plus 0.03 g/mL sufentanil, and 0.13% ropivacaine plus0.03 g/mL sufentanil. Sixty patients receiving normal delivery were enrolled as group C. The intrapartum fever, thermo-genic factors levels (IL-1β, IL-6, TNF-α), exercise retardation effect, and analgesic effect of parturient woman, as wellas Apgar score of newborns were compared. Results The incidence of fever in group B (30.0%) was significantly high-er than that in group A (20.0%) and group C (5.0%), and the incidence in group A was significantly higher than that ingroup C (P<0.05). There was no significant difference in Apgar score at 1 min and 5 min between the three groups (P<0.05). Compared with before analgesia, the tympanic membrane temperature 4 h after analgesia in group A and group Bwere significantly increased (P<0.05); In comparison between groups, the tympanic membrane temperature of group Awas significantly higher than that of group B 4 h after analgesia (P<0.05). There was no significant difference in tympan-ic membrane temperature at other time points (P>0.05). Compared with before analgesia, the levels of IL-1β, IL-6,TNF-α of parturient woman immediately after delivery were significantly increased in group A and group B (P<0.05);serum IL-1β, IL-6, and TNF-α levels of pregnant women in group B immediately after delivery were significantly high-er than those in group A (P<0.05). The modified Bromage score of group B was significantly lower than that of group Aat 0.5 h after analgesia and the fetus was delivered (P<0.01). The VAS scores of the parturients in group B were signifi-cantly lower than those in group A at 10 min, 30 min after analgesia delivery, and after full uterine opening (P<0.01 or