瑞芬太尼静脉自控模式在不同产程分娩镇痛的效果观察

Analgesic effectiveness of remifentanil intravenous patient-controlled regimen in different stages of labor analgesia

目的本研究旨在探讨瑞芬太尼静脉自控镇痛(patient controlled intravenous analgesia,PCIA)方案在第一产程潜伏期、活跃期的有效性、安全性及对血浆前列腺素E2(PGE2)浓度的影响。方法选取2021年1月至2022年2月,单胎足月产妇60例,依据产妇自愿原则分为瑞芬太尼静脉分娩镇痛组(R组)和无镇痛组(C组),每组30例。R组在第一产程潜伏期瑞芬太尼背景剂量0.03μg/(kg·min),单次按压剂量0.3μg/kg,锁定时间2 min;第一产程活跃期:瑞芬太尼背景剂量0.05μg/(kg·min),单次按压剂量0.4μg/kg,锁定时间2 min。记录两组产妇疼痛、镇静、满意度评分;产妇及胎儿不良反应;新生儿Apgar评分和脐动脉血气分析值;R组镇痛前后血浆PGE2浓度值。结果与C组比较,R组潜伏期、活跃期平均疼痛评分和最低疼痛评分均显著降低(P<0.05)。R组镇静评分、满意度评分高于C组(P<0.05)。R组头晕、困倦发生率较高(P<0.05)。两组新生儿脐动脉血气分析及Apgar评分差异无统计学意义(P>0.05)。R组镇痛前、后血浆中PGE2浓度差异无统计学意义(P>0.05)。结论根据产程潜伏期和活跃期不同产痛强度,适当调整瑞芬太尼PICA模式,可以明显缓解产妇的分娩痛,对母婴无明显不良反应,对产妇PGE2浓度无影响。

Objective To investigate the effectiveness and safety of intravenous remifentanil patient-controlled intravenous analgesia(PCIA)regimen during the active and latency period of the first labor and its influence on plasma prostaglandin E2(PGE2)in parturients.Methods A total of 60 full-term parturients with a single fetus giving birth vaginally in our center from January 2021 to February 2022 were enrolled in this study.The patients who were willing to receive remifentanil intravenous controlled analgesia formed group R(n=30),and those who refused analgesia formed group C(n=30).Group R received PCA of remifentanil(continuous background infusion of 0.03μg/kg·min and bolus doses of 0.3μg/kg with 2 min lockout period in latent phase;continuous background infusion of 0.05μg/kg·min and bolus doses of 0.4μg/kg with 2 min lockout period in active phase).Maternal pain score,sedation efficacy,satisfaction,and maternal and fetal adverse reactions were recorded.Neonatal Apgar score and the results of umbilical arterial blood gas analysis were recorded.The levels of PGE2 in R group were determined before and after analgesia.Results Compared to Group C,the mean NRS pain score and the lowest pain score of Group R in latent and active phases were significantly lower(P<0.05).The overall sedation score and satisfaction score of Group R were obviously higher when compared with Group C(P<0.05).The incidences of dizziness and drowsiness were statistically higher in the Group R(P<0.05).No differences were seen in the neonatal Apgar score and the results of umbilical arterial blood gas analysis between the 2 groups(P>0.05).The serum PGE2 levels had no obvious change in Group R before and after analgesia(P>0.05).Conclusion According to the different intensities of labor pain in latent and active phase,appropriate adjustment of remifentanil intravenous controlled analgesia regimen can obviously mitigate maternal labor pain,without obvious maternal and fetal adverse reactions,and has no influence on maternal PGE2 levels.