瑞芬太尼静脉自控式给药用于分娩过程中的镇痛效果以及安全性评估

目的探讨瑞芬太尼静脉自控式给药用于分娩过程中的镇痛效果以及安全性。方法选取2017年2月-2018年3月在南京医科大学第二附属医院和南京医科大学附属逸夫医院足月单胎顺产孕产妇201例,按照镇痛方法分为静脉自控给药组(110例)、硬膜外麻醉组(35例)及对照组(56例,无镇痛),分别对3组的镇痛效果(中文简化McGill疼痛量表)、不良反应、生命体征、剖宫产率、3组新生儿出生后的Apgar评分、婴儿期的发育筛查测验评分进行比较分析。结果硬膜外麻醉组与静脉自控给药组均有一定的镇痛效果,硬膜外麻醉组的各项疼痛评分明显低于静脉自控给药组,差异有统计学意义(均P<0.05)。硬膜外麻醉组及静脉自控给药组的血压在用药后均有不同程度的下降,以硬膜外麻醉组明显,差异有统计学意义(均P<0.05),考虑是硬膜外阻滞麻醉镇痛效果更佳,从而降低了产妇因分娩疼痛而引起的血压升高这一不良反应发生率。硬膜外麻醉组第二产程时间有所延长,与静脉给药组及对照组第二产程时间比较,差异有统计学意义(均P<0.05)。3组产妇在分娩过程中总不良反应发生率比较,硬膜外麻醉组及静脉自控给药组高于对照组,其余各项生命体征、剖宫产率、产钳助产率,3组新生儿出生1 min、5 min Apgar评分以及婴儿期的发育筛查测验比较,差异均无统计学意义(均P>0.05)。结论瑞芬太尼静脉自控式给药作为一种新型分娩镇痛方式,镇痛效果虽不及硬膜外阻滞麻醉,但其不影响第二产程进展,不良反应少,操作简单,仍是一种相对安全且有效的分娩镇痛方式。

Evaluation of the efficacy and safety of patient-controlled intravenous analgesia with remifentanil during labor

Objective This paper evaluates the efficacy and safety of patient-controlled analgesia (PCA) with remifentanil during labor. Methods From February 2017 to March 2018, a total of 201 cases of parturients who delivered in Second Affiliated Hospital of Nanjing Medical University and Nanjing Medical University Sir Run Run Hospital were enrolled as subjects. According to the analgesic techniques, the 201 parturients were divided into the PCIA Group (n=110), the Epidural Anesthesia Group (n=35) and the Control Group (n=56). The parameters include pain scale of parturients, which is the scale of the Chinese version of the Short Form-McGill Pain Questionnaire (SF-MPQ), side effects, the vital signs during labor, rate of caesarean section, the newborns' one-minute and five-minute Apgar Score, and the DST result of newborns' at infancy stage. Results In comparison to the Control Group, there was a significant decrease of pain scores both in the Remifentanil Group and the Epidural Group(all P<0.05), but with higher pain scores in the Remifentanil Group. After the administration of the medication, subjects in both the Remifentanil group and the Epidural group experienced lowering in blood pressure, especially those in the Epidural group, and the difference was statistically significant (all P<0.05). Since epidural analgesia is more effective in pain relief than remifentanil, its administration is more effective in decreasing the risk of pain-induced hypertension during labor. But Epidural analgesia could extend the duration of the second stage of the labor. Compared with the PCIA Group and the control group, The duration in the Epidural Group is statistically significantly longer (all P<0.05). The incidence of side effects in Epidural Group was far higher than that in the other two groups, and the difference was statistically different(all P<0.05).There was no significant difference in the vital signs, the cesarean section rate, and forceps delivery rate among all three groups. There was no significant in the 1min Apgar score and 5min Apgar score of the newborns(all P>0.05) among all three groups. In addition, there was no significant difference in the newborns' the DST result(all P>0.05). Conclusion Compared to epidural anesthesia, which has more advanced analgesic effect, the patient-controlled intravenous analgesia with remifentanil, as a new analgesic technique, is still an effective and safe procedure which significantly relieves pain, has less impact on the duration of the second stage of labor, has less side effects on the parturients, and is simple to operate.