不同镇痛方式对分娩的镇痛效果及其对分娩结局的影响

The analgesic effects of different analgesic methods and their influences on pregnant outcomes

目的探讨不同镇痛方式对分娩的镇痛效果及其对分娩结局的影响。方法选择2019年3月至2020年3月间,于温岭市妇幼保健院自愿要求分娩镇痛的140例自然分娩产妇为研究对象,按照不同分娩镇痛方式分为观察组(70例)与对照组(70例)。对照组给予罗哌卡因与舒芬太尼联合硬膜外自控分娩镇痛;观察组给予瑞芬太尼静脉自控分娩镇痛。比较两组镇痛前、镇痛后10min和镇痛后60min数字疼痛分级法(NRS),镇痛时间和镇痛泵有效按压次数,不同产程时间,新生儿出生1min和5min的Apgar评分。结果两组镇痛前NRS评分比较无统计学差异(t=0.280,P>0.05);观察组镇痛后10min和镇痛后60min的NRS评分显著低于对照组(t值分别为16.058、8.212,均P<0.05)。观察组镇痛时间显著长于对照组,镇痛泵的有效按压次数显著少于对照组(t值分别为8.977、11.630,均P<0.05)。两组第一产程时间、第二产程时间和第三产程时间比较无统计学差异(t值分别为0.565,0.363、0.639,均P>0.05)。两组新生儿出生1min和5min的Apgar评分比较无统计学差异(t值分别为0.446、0.942,均P>0.05)。观察组产妇对分娩镇痛总满意率(95.71%)显著高于对照组(80.00%)(χ^(2)=8.101,P<0.05)。结论瑞芬太尼静脉自控分娩镇痛法对分娩产妇镇痛效果优于罗哌卡因与舒芬太尼联合硬膜外自控分娩镇痛法,且产妇对瑞芬太尼静脉自控分娩镇痛法的满意度高,且两种方式间的分娩结局无显著差异。

Objective To investigate the analgesic effects of different analgesia methods and influences on pregnant outcomes.Methods A total of 140 parturient women who voluntarily requested labor analgesia in Wenling Maternal and Child Health Hospital from March 2019 to March 2020 were selected as the research objects,and divided into observation group(n=70)and control group(n=70)according to different methods of labor analgesia.The control group was given ropivacaine combined with sufentanil for patient-controlled epidural labor analgesia,while the observation group was given remifentanil intravenous patient-controlled labor analgesia.The numerical rating scale(NRS)scores before analgesia,10 minutes after analgesia and 60 minutes after analgesia were compared between the two groups,and the analgesic time and effective pressing times of analgesia pump,different labor process time,Apgar score of newborn 1 min and 5 min after birth between the two groups were compared.Results There was no significant difference in NRS score between the two groups before analgesia(t=0.280,P>0.05);NRS scores of the observation group were lower than those in the control group at 10 min and 60 min after analgesia(t=16.058 and 8.212,respectively,both P<0.05).Analgesic time of the observation group was longer than that in the control group,and effective pressing times analgesia pump was less than the control group(t=8.977 and 11.630,respectively,both P<0.05).There was no significant difference in the first stage of labor,the second stage of labor and the third stage of labor between the two groups(t=0.565,0.363 and 0.639,respectively,all P>0.05).There was no significant difference in Apgar score at 1 min and 5 min after birth between the two groups(t=0.446 and 0.942,respectively,both P>0.05).The overall satisfaction rate of labor analgesia in the observation group(95.71%)was higher than that in the control group(80.00%)(χ^(2)=8.101,P<0.05).Conclusion The analgesic effect of remifentanil patient-controlled labor analgesia is better than ropivacaine combined with sufentanil for patient-controlled epidural labor analgesia.The satisfaction of the parturient women with remifentanil intravenous delivery analgesia is higher,and there is no significant difference in pregnant outcomes between the two methods.