瑞芬太尼静脉自控分娩镇痛对产后抑郁的影响

Influence of Patient-controlled Intravenous Labor Analgesia with Remifentanil in Postpartum Depression

目的:探讨瑞芬太尼静脉自控分娩镇痛对产后抑郁的影响。方法:选取2017年11月-2018年6月于本院分娩的顺产初产妇150例。按照随机数字表法将其分为瑞芬太尼组、硬膜外组和对照组,各50例。瑞芬太尼组采用瑞芬太尼静脉自控分娩镇痛,硬膜外组采用罗哌卡因联合舒芬太尼联合的硬膜外腔注射镇痛,对照组常规行自然分娩,不做镇痛措施。比较三组产程时间、产时出血量、新生儿Apgar评分、产时疼痛及产后抑郁情况(EPDS评分)。结果:三组产程时间、产时出血以及新生儿Apgar评分比较,差异均无统计学意义(P>0.05);自镇痛1 h后至胎儿娩出时,三组VAS评分比较差异均有统计学意义(P<0.05),其中瑞芬太尼组与硬膜外组VAS评分均低于对照组,且硬膜外组均低于瑞芬太尼组;产后3、42 d,三组EPDS评分、抑郁确诊例数比较,差异均有统计学意义(P<0.05),其中瑞芬太尼组均低于硬膜外组与对照组。结论:瑞芬太尼静脉自控镇痛不仅有助于分娩的顺利进行,同时可降低产时疼痛,极大程度上降低产后抑郁,改善产妇家庭情况,值得在临床推广。

Objective:To discuss the influence of patient-controlled intravenous labor analgesia with Remifentanil in postpartum depression.Method:A total of 150 primipara underwent the spontaneous labor from November 2017 to June 2018 in our hospital were selected.According to the random number table method,they were divided into Remifentanil group,epidural group and control group,50 cases in each group.Remifentanil group was given patient-controlled intravenous labor analgesia with Remifentanil,epidural group was given Ropivacaine combined with Sufentanil for epidural analgesia,and control group was given natural delivery routinely without any analgesic measures.The duration of labor,intrapartum hemorrhage,neonatal Apgar score,intrapartum pain and postpartum depression(EPDS score)between three groups were compared.Result:The duration of labor,intrapartum hemorrhage,neonatal Apgar score in three groups were compared,the differences were not statistically significant(P>0.05).From 1 hour after analgesia to the time of fetal delivery,the VAS scores in three groups were compared,the differences were statistically significant(P<0.05),and the VAS score of Remifentanil group and epidural group were lower than those of control group,the VAS score of epidural group were lower than those of Remifentanil group.After 3 and 42 d of delivery,the EPDS score and the number of confirmed cases of depression in three groups were compared,the difference were statistically significant(P<0.05),and Remifentanil group were lower than those of epidural group and control group.Conclusion:Patient-controlled intravenous labor analgesia with Remifentanil can not only help the smooth delivery,but also reduce the pain during delivery,greatly reduce postpartum depression and improve maternal and family conditions,which is worthy of clinical promotion.