无痛分娩中不同剂量瑞芬太尼对产妇疼痛、下肢运动神经阻滞影响

Effects of different doses of remifentanil for painless delivery of pregnant women on their pain and motor nerve block of lower extremity

目的:探究不同剂量瑞芬太尼对行无痛分娩产妇疼痛视觉模拟(VAS)评分、下肢运动神经阻滞(Bromage)评分的影响。方法:选取2018年10月-2020年11月在本院行无痛分娩的产妇152例,随机数字表法分为1mg组和1.5mg组各76例,分别使用1mg或1.5mg瑞芬太尼麻醉,观察两组产妇麻醉前、麻醉30min、麻醉6h VAS评分、生命体征[血压(BP)、心率(HR)、呼吸频率(RR)]、皮质醇(Cor)、肾上腺素(ADR)、白细胞介素-6(IL-6)水平,产后产妇Bromage评分及新生儿Apgar评分,统计不良反应。结果:两组VAS评分麻醉30min时均降低、麻醉6h时均升高,麻醉30min、6h时BP、HR、RR水平均降低,Cor、ADR、IL-6水平均升高;与麻醉30min相比,两组麻醉6h时VAS评分、BP、HR、RR水平均升高,Cor、ADR、IL-6水平均降低,且1mg组麻醉30min、麻醉6h时Cor、ADR、IL-6水平均低于1.5mg组,VAS评分(1.67±0.68分、.89±0.36)均高于1.5mg组(1.04±0.85分、3.27±0.23分),不良反应总发生率(4.0%)低于1.5mg组(13.2%),BP、HR、RR水平均高于1.5mg组,产妇分娩成功后Bromage评分(0.84±0.36分)低于1.5mg组(1.13±0.47分),新生儿Apgar评分(9.57±0.38分)高于1.5mg组(8.81±0.26分)(均P<0.05)。结论:1mg剂量瑞芬太尼即可改善无痛分娩产妇VAS评分,降低Bromage评分,降低不良反应,提高新生儿Apgar评分。

Objective: Effects of different doses of remifentanil for painless delivery of pregnant women on their visual analogue scale(VAS) score and motor nerve block of lower extremity(Bromage) score. Methods: 152 pregnant women who wanted painless delivery were selected and were randomly divided into two groups(76 cases in each group) by random number table from October 2018 to November 2020. The women in group A were given 1.5 mg remifentanil for analgesia, and the women in group B were given 1 mg remifentanil for analgesia. The VAS score, the values of vital signs, such as blood pressure(BP), Heart rate(HR), respiratory rate(RR), the levels of cortisol(Cor), adrenaline(ADR), and interleukin-6(IL-6), and Bromage score of the women before anesthesia, in anesthesia 30 min, and in anesthesia 6 h, and the Apgar score of the newborn were observed. The incidence of adverse reactions was calculated. Results: VAS scores of the women in both groups had decreased significantly in anesthesia 30 min, but which had increased significantly in anesthesia 6 h. The values of BP, HR, and RR of the women in both groups had decreased in anesthesia 30 min and 6 h significantly, and the levels of Cor, ADR, and IL-6 of the women in both groups had increased significantly in anesthesia 30 min and 6 h. The VAS score and the values of BP, HR, and RR of the women in both groups in anesthesia 6 h were significantly higher than those in anesthesia 30 min, while the Cor, ADR and IL-6 levels of the women in both groups in anesthesia 6 h were significantly lower. The Cor, ADR and IL-6 levels of the women in group B in 30 min and 6 h of anesthesia were significantly lower than those of the women in group A.VAS score of the women in group B in 30 min and 6 h of anesthesia(1.67±0.68 points and 89±0.36 points)were significantly higher than those(1.04±0.85 points and 3.27±0.23 points)of the women in group A.The total incidence of adverse reactions(4.0%)of the women in group B was significantly lower than that(13.2%)of the women in group A,and the values of BP,HR,and RR of the women in group B were significantly higher than those of the women in group A.The Bromage score(0.84±0.36 points)of the women in group B after delivery successfully was significantly lower than that(1.13±0.47 points)of the women in group A.Apgar score(9.57±0.38points)of the newborn in group B was significantly higher than that(8.81±0.26 points)of the newborn in group A(all P<0.05).Conclusion:1mg remifentanil for painless delivery of the pregnant women can improve their VAS score,reduce their Bromage score and incidence of adverse reactions,and improve Apgar score of their newborn.