丙泊酚复合瑞芬太尼或芬太尼对行无痛胃镜检查的哺乳妇女泌乳功能的影响

Effects of propofol combined with remifentanil or fentanyl on the lactation function in lactating women undergoing painless gastroscopy

目的探讨丙泊酚复合瑞芬太尼或芬太尼对行无痛胃镜检查的哺乳妇女泌乳功能的影响。方法选取2017年6月至2019年3月在廊坊市第四人民医院行胃镜检查的105例哺乳期妇女作为研究对象。采用数字列表法将其随机分为三组:A组(丙泊酚+瑞芬太尼)、B组(丙泊酚+芬太尼)和C组(普通胃镜检查),每组35例。观察三组研究对象局部麻醉前(基础值)、入镜(检查前)、镜体过声门(检查中)、出镜(检查后)平均动脉压(MAP)、心率(HR)、血氧饱和度(SpO2)。记录A组和B组研究对象苏醒时间、离开恢复室时间及检查中呛咳、体动和检查后眩晕、恶心呕吐等不良反应发生率。测定三组研究对象基础值、检查后、检查1d的血浆催乳素(PRL)水平。结果①与基础值比较,A组、B组研究对象检查前MAP、HR均有所降低(均P<0.05),C组研究对象检查中、检查后MAP、HR均有所升高(均P<0.05)。A组、B组研究对象检查前、检查中、检查后MAP、HR均低于C组研究对象均有所下降(均P<0.05)。三组研究对象不同观察时间点SpO2无明显变化。②A组研究对象苏醒时间和离开恢复室时间均短于B组研究对象(P<0.05)。③A组和B组研究对象呛咳、一般体动、头晕、恶心呕吐的发生率均低于C组研究对象(均P<0.05),A组研究对象头晕的发生率低于B组研究对象(P<0.05)。④A组、B组研究对象检查后PRL水平与基础值比较均有所升高(均P<0.05),C组研究对象检查后PRL水平与基础值比较有所降低(P<0.05),且A组、B组研究对象检查后PRL水平均明显高于C组研究对象(均P<0.05)。结论丙泊酚复合瑞芬太尼或芬太尼均能够有效减轻行无痛胃镜检查哺乳妇女的应激和不良反应,促进PRL分泌。与丙泊酚复合芬太尼相比,丙泊酚复合瑞芬太尼能够明显提高研究对象苏醒质量,值得临床推广。

Objective To discuss the effects of propofol combined with remifentanil or fentanyl on the lactation function in lactating women undergoing painless gastroscopy. Methods A total of 105 lactating women who underwent gastroscopy in the fourth people′s hospital of langfang city from June 2017 to March 2019 were selected as the research objects and randomly divided into three groups by numerical list method: group A(propofol + remifentanil), group B(propofol + fentanyl) and group C(general gastroscopy) according to the number list method, with 35 cases in each group. Mean arterial pressure(MAP), heart rate(HR) and oxyhemoglobin saturation(SpO2) were observed before local anesthesia(basic value), before endoscopy(before examination), gastroscopy through the glottis(during examination) and after endoscopy(after examination). The incidence of adverse reactions such as waking time, time to leave the recovery room, choking and coughing during examination, body movement during examination and dizziness, nausea and vomiting after examination were recorded in group A and group B. The levels of plasma prolactin(PRL) with respect to basic value, after examination, a day after examination were measured in the three groups. Results ① Compared with the basic values, MAP and HR decreased before examination in group A and group B(all P<0.05), while MAP and HR increased during and after examination in group C(all P<0.05). MAP and HR of group A and group B decreased before, during and after examination compared with group C(all P<0.05). There was no significant change in SpO2 at different observation time points between different groups. ② Time of waking up and time to leave the recovery room in group A was shorter than that in group B(all P< 0.05). ③ The incidence of choking, general body movement, dizziness, nausea and vomiting in group A and group B was lower than that in group C(all P<0.05), and the incidence of dizziness in group A was lower than that in group B(P<0.05). ④ PRL level of group A and group B increased and that of group C decreased compared with the basic values(all P<0.05), and PRL level of group A and group B was significantly higher than that of group C(all P<0.05). Conclusions Propofol combined with remifentanil or fentanyl can effectively alleviate the stress and adverse reactions of lactating women who have received painless gastroscopy, and promote the secretion of PRL. Compared with propofol combined with fentanyl, propofol combined with remifentanil can significantly improve the quality of patients′ waking, which is worthy of clinical promotion.