瑞芬太尼静脉自控分娩镇痛联合“2+1”导乐陪伴分娩模式对无痛分娩孕妇产后的影响

Effects of patient-controlled intravenous labor analgesia with remifentanil combined with“2+1”guided delivery mode on maternal condition after painless labor

目的探讨瑞芬太尼静脉自控分娩镇痛联合“2+1”导乐陪伴分娩模式对无痛分娩孕妇产后出血、新生儿免疫球蛋白G(IgG)水平的影响。方法108例产妇的临床资料,根据麻醉方法的不同分为观察组和对照组,每组54例。2组均接受“2+1”导乐陪伴分娩模式干预,对照组应用舒芬太尼联合罗哌卡因硬膜外自控分娩镇痛,观察组应用瑞芬太尼静脉自控分娩镇痛。比较2组孕妇生产时母婴结局、产痛、产程时间,产后出血情况及新生儿娩出时脐带血指标。结果观察组孕妇产后出血率低于对照组(P<0.05);观察组孕妇产后2 h出血量低于对照组(P<0.05);观察组孕妇的产痛Ⅲ、Ⅱ级比例低于对照组,Ⅰ、0级比例高于对照组照组(P<0.05);观察组孕妇的阴道分娩率高于对照组(P<0.05);观察组新生儿并发症发生率低于对照组(P<0.05);观察组孕妇的第一产程、第二产程、第三产程时间均短于对照组(P<0.05)。观察组新生儿脐带血二氧化碳分压(PaCO2)水平低于对照组,IgG、血氧分压(PaO2)水平高于对照组(P<0.05)。结论瑞芬太尼静脉自控分娩镇痛联合“2+1”导乐陪伴分娩模式可降低无痛分娩孕妇产后出血及产痛,缩短产程,优化母婴结局,提高母体给予新生儿免疫防御能力,改善新生儿血气指标。

Objective To investigate the effects of patient-controlled intravenous labor analgesia with remifentanil combined with“2+1”guided delivery mode on postpartum hemorrhage of parturients after painless labor and the IgG levels of neonates.Methods A total of 108 pregnant women were divided into observation group(n=54)and control group(n=54)according to different anesthetic methods.The pregnant women in both groups underwent“2+1”guide accompanied delivery pattern intervention.Then the pregnant women in control group were treated by remifentanil combined with patient-controlled epidural analgesia with ropivacaine,however,those in observation group were treated by patient-controlled epidural analgesia with remifentanil.The outcome of maternal and infant,labor pain,labor time,postpartum hemorrhage and the index of umbilical cord blood at delivery were observed and compared between the two groups.Results The incidence rate of postpartum hemorrhage in observation group(1.85%)was significantly lower than that(14.81%)in control group(P<0.05).The postpartum hemorrhage volume at 2h after labor in observation group was significantly lower than that in control group(P<0.05).The proportion of labor pain of gradeⅢandⅡin observation group was significantly lower than that in control group,but the proportion of grade I and grade 0 was significantly higher than that in control group(P<0.05).Moreover,the vaginal delivery rate in observation group was significantly higher than that in control group(P<0.05).The incidence rate of complication of newborn in observation group was significantly lower than that in control group(P<0.05).Furthermore,the duration of first,second and third stages of labor in observation group was significantly shorter than that in control group(P<0.05).In addition,the levels of PaCO2 in observation group were significantly lower than those in control group,but the levels of IgG and PaO2 were significantly higher than those in control group(P<0.05).Conclusion The patient-controlled intravenous labor analgesia with remifentanil combined with“2+1”guide accompanied delivery pattern can reduce the postpartum hemorrhage and labor pain,shorten labor course,improve the outcome of maternal and infant as well as neonatal immune response and blood gas index.