瑞芬太尼静脉分娩镇痛复合罗哌卡因穴位注射分娩镇痛的镇痛效果及其对产妇皮质醇水平的影响

Analgesic effects of intravenous remifentanil injection combined with ropivacaine acu-point injection and its influences on cortisol in pregnant women

目的探讨瑞芬太尼静脉分娩镇痛复合罗哌卡因合谷穴、三阴交穴穴位注射分娩镇痛的镇痛效果及其对产妇皮质醇水平的影响。方法自愿要求静脉分娩镇痛的120例初产妇随机分为两组:瑞芬太尼静脉分娩镇痛组(A组)和瑞芬太尼静脉分娩镇痛复合穴位分娩镇痛组(B组)。A组在双侧三阴交穴、合谷穴注入0.9%生理盐水1 mL;B组在双侧三阴交穴、合谷穴注入0.2%罗哌卡因1 mL。两组瑞芬太尼静脉分娩镇痛泵配方相同。比较两组产妇镇痛前、镇痛后的VAS评分,呼吸频率,脉搏血氧饱和度,皮质醇浓度,新生儿Apgar评分及脐动脉血p H值。结果产妇镇痛后的呼吸频率、脉搏血氧饱和度AB两组均较镇痛前降低(P <0.05);但组间差异无统计学意义(P> 0.05)。B组产妇镇痛后的VAS评分较A组、镇痛前明显降低(P <0.05)。两组产妇镇痛1、2 h的血中皮质醇浓度低于镇痛前(P <0.05);且B组显著低于A组(P <0.05)。AB两组的新生儿Apgar评分及脐动脉血pH值比较差异无统计学意义(P> 0.05)。结论瑞芬太尼静脉分娩镇痛复合罗哌卡因合谷穴、三阴交穴穴位注射分娩镇痛与单纯采用瑞芬太尼静脉分娩镇痛相比,可以明显降低患者血中的皮质醇浓度,减轻患者的疼痛而不会增加呼吸系统并发症,对新生儿的Apgar评分及脐动脉血pH值无影响。

Objective To investigate the analgesic effects of remifentanil intravenous injection combined with ropivacaine acu-point(at Hegu and Sanyinjiao)injection and its influences on the cortisol in pregnant women.Methods A total of 120 nulliparous women who volunteered for intravenous delivery analgesia were randomly as-signed to 2 groups:remifentanil intravenous analgesia group(group A)and remifentanil intravenous analgesia com-bined with ropivacaine at Hegu and Sanyinjiao acupoints group(group B). In group A,women received a dose of 0.9% NS 1 mL in bilateral Sanyinjiao and Hegu acupoints. In group B,women received a dose of 0.2% ropivacaine 1 mL in bilateral Sanyinjiao and Hegu acupoints. Remifentanil intravenous analgesia pump formula in the two groups were the same. The visual analogue scale(VAS)before and after analgesia were compared between the two groups. Respiratory frequency,pulse oxygen saturation,cortisol concentration,Apgar score and umbilical arterialpH value were compared.Results Respiratory frequency and pulse oxygen saturation of the two groups after anal-gesia were lower than those before analgesia(P < 0.05),but there was no significant difference between the twogroups(P > 0.05). The VAS score of group B after analgesia were significantly lower than that of group A and be-fore analgesia(P < 0.05). The serum cortisol concentration in the two group after analgesia for 1 hour and 2 hours was lower than those before analgesia(P < 0.05),and that in group B was significantly lower than that in group A(P < 0.05). There was no significant difference in neonatal Apgar score and umbilical artery blood p H value be-tween the two groups(P > 0.05).Conclusions Remifentanil intravenous analgesia combined with ropivacaine acu-points analgesia at Hegu and Sanyinjiao could significantly reduce the concentration of cortisol compared with remi-fentanil alone. It could relieve pain without increasing respiratory complications and have no influence on Apgar score and umbilical artery blood p H value in neonates.