术前应用瑞芬太尼对妊娠高血压综合征剖宫产的影响

Effect of remifentanil on cesarean section in hypertensive syndrome of pregnancy

目的探讨瑞芬太尼应用于妊娠高血压综合征剖宫产术前的效果及安全性。方法选取2019年1月至2020年12月于本院拟行剖宫产的50例妊娠高血压综合征孕妇作为研究对象,随机分为观察组与对照组,每组25例。观察组首先在1 min内静脉注射瑞芬太尼40μg(2 ml),再连接含30 mg/L瑞芬太尼静脉镇痛泵,予6 ml/h匀速泵入,调整体位行蛛网膜下腔穿刺;对照组首先在1 min内静脉注射0.9%氯化钠溶液2 ml,再连接含0.9%氯化钠溶液静脉镇痛泵,予6 ml/h匀速泵入,调整体位行蛛网膜下腔穿刺。比较两组处理前5 min(T_(0))、处理后5 min(麻醉前,T_(1)),麻醉后10 min(切皮前,T_(2))、切皮后(T_(3))、关腹时(T_(4))的平均动脉压(MAP)、心率(HR)、呼吸频率(RR)和血氧饱和度(SPO_(2))及新生儿Apgar评分、母体和新生儿不良反应和满意度情况。结果两组MAP组间、时间、交互比较差异有统计学意义(P<0.05)。两组HR、RR时间比较差异有统计学意义(P<0.05);组间、交互比较差异无统计学意义。两组SPO_(2)组间、时间、交互比较差异无统计学意义。T_(0)时,两组MAP、HR比较差异无统计学意义;T_(1)~T_(4)时,观察组MAP均低于对照组,差异有统计学意义(P<0.05);T_(1)时,观察组HR低于对照组,T_(2)~T_(4)时,观察组HR均高于对照组,差异有统计学意义(P<0.05);T_(2)~T_(4)时,两组RR比较差异均无统计学意义。观察组满意度为100.00%,高于对照组的48.00%,差异有统计学意义(P<0.05)。两组低SPO_(2)、呼吸抑制及新生儿窒息发生率比较差异无统计学意义;观察组头晕发生率均高于对照组,焦虑发生率低于对照组,差异有统计学意义(P<0.05)。两组1、5 min Apgar评分比较差异无统计学意义。结论妊娠高血压综合征术前应用瑞芬太尼能够使产妇循环更稳定,可提高产妇满意度,值得临床推广应用。

Objective To investigate the efficacy and safety of remifentanil in patients with hypertensive syndrome of pregnancy before cesarean section.Methods 50 pregnant women with hypertensive syndrome of pregnancy who planned to undergo cesarean section in our hospital from January 2019 to December 2020 were selected as study subjects and they were randomly divided into observation group and control group,with 25 cases in each group.In the observation group,40μg(2 ml)of remifentanil was injected within 1 min,then an intravenous analgesic pump containing 30 mg/L remifentanil was injected at a constant rate of 6 ml/h,and subarachnoid puncture was performed after adjusting the position.In the control group,2 ml of normal saline was injected within 1 min,and then the intravenous analgesia pump containing normal saline was connected,and 6 ml/h was injected at a uniform speed,and subarachnoid puncture was performed after adjusting the position.The mean arterial pressure(MAP),heart rate(HR),respiratory rate(RR),oxygen saturation(SPO_(2)),neonatal Apgar score,maternal and neonatal adverse reactions and satisfaction at 5 min before treatment(T_(0)),5 min after treatment(before anesthesia,T_(1)),10 min after anesthesia(before skin incision,T_(2)),after skin incision(T_(3))and abdominal closure(T_(4))were compared between the two groups.Results There were significant differences in MAP between the two groups of group,time points and interaction(P<0.05).There were significant differences in HR and RR between the two groups of time(P<0.05);there was no significant difference between the two groups.There were no significant differences in SPO_(2) between the two groups of group,time points and interaction.There was no significant difference in T_(0) MAP and HR between the two groups.T_(1)-T_(4) in observation group MAP were lower than those in control group,the differences were statistically significant(P<0.05);T_(1) HR in observation group was lower than that in control group,T_(2)-T_(4) in HR in observation group were higher than those in control group,the differences were statistically significant(P<0.05).T_(2)-T_(4),there was no significant difference in RR between the two groups.The satisfaction rate in observation group was 100.00%,which was higher than 48.00%in control group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of bradycardia,low SPO_(2),respiratory depression and neonatal asphyxia between the two groups.The incidence of bradycardia and dizziness in the observation group was higher than that in the control group,and the incidence of anxiety was lower than that in the control group,and the differences were statistically significant(P<0.05).There was no significant difference in nenatal Apgar score at 1 min and 5 min between the two groups.Conclusion The use of remifentanil before operation for hypertensive syndrome of pregnancy can make maternal circulation more stable and improve maternal satisfaction,which is worthy of clinical promotion and application.