瑞芬太尼静脉自控镇痛在分娩镇痛中的应用效果及对产妇皮质醇和去甲肾上腺素水平的影响

目的探讨瑞芬太尼患者静脉自控镇痛(PCIA)在分娩镇痛中的应用效果及对产妇血清皮质醇(Cor)、去肾上腺素(NE)水平的影响。方法将足月待产的284例产妇随机分为A组(142例,瑞芬太尼PCIA)和B组142例,罗哌卡因联合舒芬太尼患者硬膜外自控镇痛(PCEA)]。同时,选择同期在我院进行分娩的150例不要求镇痛的产妇作为C组。比较三组产妇的分娩镇痛效果及血清Cor、NE水平。结果镇痛后10、20 min及宫口全开时,A、B组的VAS评分低于镇痛前及C组(P<0.05),而A、B组镇痛后10、20 min的VAS评分无显著差异(P>0.05)。A组第一、二产程时间短于B、C组,C组短于B组(P<0.05)。三组新生儿Apgar评分比较,差异无统计学意义(P>0.05)。A、B组药物相关不良反应总发生率无显著差异(P>0.05)。分娩后30 min,A、B组的血清NE、Cor水平低于分娩前及C组,A组低于B组(P<0.05),C组则无明显变化(P>0.05)。结论本研究的两种镇痛方式用于产妇分娩镇痛中均可减轻产妇的疼痛程度,且镇痛效果相当、对产妇和新生儿均无不良影响,但瑞芬太尼PCIA可有效缩短产程,降低血清Cor、NE水平,是一种安全有效的分娩镇痛模式。

Application effect of patients-controlled intravenous analgesia with remifentanil in labor analgesia and its influence on the levels of maternal cortisol and norepinephrine

Objective To investigate the application effect of patients-controlled intravenous analgesia(PCIA)with remifentanil in labor analgesia and its influence on the levels of maternal cortisol(Cor)and norepinephrine(NE).Methods A total of 284 full-term parturients were randomly divided into group A(142 cases,remifentanil PCIA)and group B142 cases,ropivacaine combined with sufentanil for patients-controlled epiduralanalgesia(PCEA)].Meanwhile,150 parturients who did not require analgesia during delivery in our hospital were selected as group C.The analgesic effect and levels of serum Cor and NE were compared among the three groups.Results At 10 and 20 min after analgesia and when the uterus was fully opened,VAS scores of the group A and B were lower than those before analgesia and the group C(P<0.05),there were no significant differences in VAS scores of the group A and B at 10 and 20 min after analgesia(P>0.05).The first and second stage of labor time in the group A were shorter than those in the group B and C,while that in the group C was shorter than the group B(P<0.05).There was no significant difference in Apgar score among the three groups(P>0.05).There was no significant difference in the total incidence of drug-related adverse reactions between the group A and B(P>0.05).At 30 min after delivery,the levels of serum NE and Cor in the groups A and B were lower than those before delivery and the group C,and those in the group A were lower than the group B(P<0.05),while there was no significant change in the group C(P>0.05).Conclusion The two analgesia methods of the study can reduce the degree of parturients’pain in labor analgesia.The analgesia effect is similar,and there are no adverse effects on the maternal and newborn.However,remifentanil PCIA can effectively shorten the labor process,and reduce the levels of serum Cor and NE,which is a safe and effective labor analgesia mode.