Samanta Sukhen, Jain Kajal, Bhardwaj Neerja, Jain Vanita, Singh Preet Mohinder, Samanta Sujay, Singla Veenu, Saha Rini
Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Department of Anaesthesia and Intensive Care, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Anaesthesiol Clin Pharmacol. 2018 Jan-Mar;34(1):11-17. doi: 10.4103/joacp.JOACP_150_16.
Fetuses with abnormal umbilical blood flow are at a higher risk of adverse perinatal outcome than those with normal flow. Epidural analgesia (EA) has shown to decrease villous vascular resistance in preeclamptic women during labor. The present study evaluates the effects of epidural ropivacaine and intramuscular (IM) tramadol on Doppler blood flow in parturients with fetal growth restriction and raised umbilical artery (UmA) blood flow.
In this prospective nonrandomized comparative study, 36 term parturients with sonographic evidence of UmA systolic-diastolic (S-D) ratio ≥3 were enrolled. Parturients received either continuous epidural ropivacaine 0.2% or 1 mg/kg IM tramadol 4-6 hourly. Doppler flow parameters of UmA and bilateral uterine arteries (UtAs) were measured at 0, 1, and 6 h of labor analgesia. Doppler indices change with time during labor analgesia was assessed as the primary outcome. Change of Doppler indices of UtAs, Apgar score, and cord blood gases was considered as secondary measures.
Data from thirty laboring women who completed the study were analyzed. The pulsatility index, resistance index, and S-D ratio in UmA and right UtA reduced significantly with continuous epidural infusion during first 6 h of labor. However, these values increased or unchanged with tramadol administration. Better neonatal pH and base deficit ( = 0.039) were observed with EA.
Continuous epidural ropivacaine causes improved fetoplacental circulation in parturients with growth-restricted fetuses having raised Doppler indices during labor analgesia. We also found better neonatal outcome with continuous infusion of epidural ropivacaine as compared to IM tramadol.
脐血流异常的胎儿发生围产期不良结局的风险高于血流正常的胎儿。硬膜外镇痛（EA）已显示可降低子痫前期妇女分娩时的绒毛血管阻力。本研究评估硬膜外罗哌卡因和肌肉注射（IM）曲马多对胎儿生长受限且脐动脉（UmA）血流升高的产妇多普勒血流的影响。
在这项前瞻性非随机对照研究中，纳入了36例足月产妇，其超声检查显示UmA收缩期与舒张期（S-D）比值≥3。产妇每4 - 6小时接受一次0.2%的连续硬膜外罗哌卡因或1 mg/kg的IM曲马多。在分娩镇痛的0、1和6小时测量UmA和双侧子宫动脉（UtAs）的多普勒血流参数。将分娩镇痛期间多普勒指数随时间的变化作为主要结局进行评估。将UtAs的多普勒指数变化、阿氏评分和脐血气作为次要指标。
分析了30例完成研究的产妇的数据。在分娩的前6小时，连续硬膜外输注期间，UmA和右侧UtA的搏动指数、阻力指数和S-D比值显著降低。然而，使用曲马多后这些值升高或未改变。EA组新生儿pH值和碱缺失情况更好（P = 0.039）。
连续硬膜外给予罗哌卡因可改善分娩镇痛期间多普勒指数升高的生长受限胎儿产妇的胎盘循环。我们还发现，与IM曲马多相比，连续输注硬膜外罗哌卡因的新生儿结局更好。
