瑞芬太尼持续静脉自控泵注给药用于产科分娩镇痛的临床应用

Clinical application of remifentanil continuous intravenous injection for labor analgesia

目的探讨瑞芬太尼持续静脉自控泵注给药用于产科分娩镇痛的最佳安全有效剂量。方法选择2018年11月至2020年6月本院收治的、拟于分娩镇痛下经阴道分娩的300例孕足月初产妇,随机分为硬膜外镇痛组(EA组)、瑞芬太尼小剂量组(RL组)和瑞芬太尼中剂量组(RM组),各100例。持续监测、记录并比较3组产妇在镇痛实施前(宫口开2~3 cm时)、镇痛后5 min、宫口开全、胎儿娩出时MAP、HR、VAS评分及Ramsay评分;记录并比较3组产妇各产程时间、转剖宫产率及分娩后产妇对镇痛的满意度;记录并比较3组新生儿娩出后1 min、5 min时Apgar评分及胎儿娩出时脐动脉血血气分析的乳酸指标。结果3组产妇各时间点MAP、HR比较,差异均无统计学意义(均P>0.05);3组产妇镇痛实施前VAS评分、Ramsay评分比较,差异均无统计学意义(均P>0.05);RL组及RM组镇痛后5 min、宫口开全时及胎儿娩出时VAS评分、Ramsay评分均高于EA组(均P<0.05);RL组镇痛后5 min、宫口开全时及胎儿娩出时VAS评分高于RM组(均P<0.05),Ramsay评分均低于RM组(均P<0.05);与EA组比较,RL组及RM组的第一产程活跃期相对延长(均P<0.05),第二、三产程及转剖宫产率差异均无统计学意义(均P>0.05);RL组、RM组镇痛满意度均低于EA组(均P<0.05);3组新生儿Apgar评分及脐动脉血乳酸浓度比较,差异无统计学意义(均P>0.05)。结论瑞芬太尼中剂量持续静脉自控泵注用于分娩镇痛效果安全有效,对母婴均无不良影响。

Objective To explore the optimal safe and effective dose of remifentanil for labor analgesia.Methods 300 primiparas who would naturally deliver under analgesia at our hospital from November,2018 to June,2020 were randomly divided into an epidural analgesia group(EA group),a remifentanil low dose group(RL group),and a remifentanil medium dose group(RM group),with 100 cases in each group.The mean arterial pressures(MAP),heart rates(HR),VAS scores,and Ramsay scores of the three groups were continuously monitored,recorded,and compared before analgesia(when the uterine opening was 2-3 cm),5 minutes after analgesia,at the time of uterine opening was 10 cm,and at the time of the fetal delivery.The times of labor,the rates of cesarean section,and the satisfaction of analgesia were recorded and compared between the three groups.The Apgar scores and lactate indicators of blood gas analysis of umbilical artery were recorded and compared.Results There were no statistical differences in MAP and HR between the three groups(all P>0.05).There were no statistical differences in VAS score and Ramsay score between the three groups before analgesia(all P>0.05).The VAS scores and Ramsay scores of the RL group and the RM group were higher than those of the EA group 5 minutes after analgesia,at the time of uterine opening was 10 cm,and at the time of the fetal delivery(all P<0.05).The VAS scores were higher and the Ramsay scores were lower in the RL group than in the RM group 5 minutes after analgesia,at the time of uterine opening was 10 cm,and at the time of the fetal delivery(all P<0.05).The active stage of the first stage of labor was longer in the RL group and the RM group than in the EA group(P<0.05);but there were no statistical difference in the second and third stages of labor and the rate of cesarean section between the 3 groups(all P>0.05).The satisfaction with analgesia was lower in the RL group and the RM group than in the EA group(both P<0.05).There were no statistical differences between the three groups in Apgar score and lactate concentration(all P>0.05).Conclusion It is safe and effective of remifentanil in medium dose continuous intravenous injection for labor analgesia,which can be used as an alternative to clinical labor analgesia.