微创腰麻联合瑞芬太尼静脉自控镇痛用于分娩镇痛64例临床评价

Clinical Evaluation on Application of Minimally Invasive Spinal Anesthesia Combined with Remifentanil PCEA in 64 Cases of Labor Analgesia

目的评价微创腰麻联合瑞芬太尼静脉自控镇痛这一新型分娩镇痛方式的应用价值。方法将医院收治的要求分娩镇痛的初产妇128例随机分为A组和B组,各64例。A组给予舒芬太尼微创腰麻联合瑞芬太尼静脉自控镇痛,B组给予舒芬太尼联合罗哌卡因硬膜外腔自控镇痛,观察记录镇痛效果、运动阻滞、产程时间、新生儿评分、总住院费用及不良反应发生情况等。结果两组产妇各时刻疼痛视觉模拟评分(VAS评分)均明显下降(P<0.05),但A组明显高于B组(P<0.05);所有产妇均未出现明显的运动阻滞;A组活跃期与B组无明显差异(P>0.05),而第二产程明显短于B组(P<0.05);两组顺产率无明显差异(P>0.05),B组剖宫产率为17.19%,明显高于A组的10.94%(P<0.05);两组新生儿生后1 min和5 min Apgar评分、生后15 min和出生后24 h神经行为与适应能力评分(24 hNACS评分)均在正常范围内,组间差异无统计学意义(P>0.05);A组在住院期间总费用较B组高(P<0.05);A组不良反应总发生率为17.19%,明显低于B组的28.13%(P<0.05)。结论微创腰麻联合瑞芬太尼静脉自控镇痛在产科分娩镇痛中,虽然花费较高,但镇痛效果确切、无明显运动阻滞且对新生儿无明显影响,还能缩短第二产程,降低剖宫产率和不良反应发生率,值得临床推广。

Objective To evaluate the application value of minimally invasive spinal anesthesia combined with remifentanil patient controlled epidural analgesia（PCEA） as a new type labor analgesia mode. Methods 128 primiparas requiring labor analgesia in our hospi- tal were randomLy divided into the group A and B,64 cases in each group. The group A was given sufentanil minimally invasive spinal anesthesia combined with the remifentanil PCEA,while the group B was given sufentanil combined with ropivacaine PCEA. The analgesic effect,motor block,duration of labor, neonatal Apgar scores,total hospital costs and occurrence situation of adverse reactions were observed and recorded. Results The visual analogue scale（VAS） scores at various timepoints in the two groups were significantly decreased （P 〈 0.05）, but the group A was significantly higher the group B （P 〈 0.05）;all primiparas had no obvious motor block; the active period had no statistical significant difference between the group A and B （P 〉 0. 05）, while the second stage of labor in the group A was significantly shorter than that in the group B （P 〈 0. 05）;the smooth delivery rate had no statistical difference between the two groups （P 〉 O. 05）,the cesarean section rate in the group B was 17. 19% ,which was higher than 10. 94% in the group A （P 〈 0.05）;the neonatal lmin,5 min Apgar scores and the 15min,24h NACS scores in the two groups were within the normal ranges without statistical differences between the two groups （P 〉 0. 05）;the total hospital cost in the group A was higher than that in the group B （P 〈 0.05）;the total occurrence rate of adverse reactions in the group A was lower than that in the group B （17.19% vs. 28. 13% , P 〈 0.05）. Conclusion Minimally invasive spinal anesthesia combined with remifentanil PCEA in labor analgesia,ahhough spending is higher,but the analgesic effect is exact without obvious motor shorten the second stage of labor, reduce the cesarean section rate and the ical promotion. block and with no obvious effect on the newborns,but also occurrence rate of adverse reactions,which is worthy of clinical promotion.