低剂量瑞芬太尼联合罗哌卡因局部浸润麻醉在初产妇分娩镇痛中的应用

Application of low dose remifentanil combined with ropivacaine in local infiltration anesthesia for labor analgesia in primipara

目的:探讨在初产妇分娩中应用低剂量瑞芬太尼联合罗哌卡因局部浸润麻醉的镇痛效果。方法:选取2021年1月至2022年12月于石狮市妇幼保健院分娩的80例初产妇为研究对象,采用随机数字表法将初产妇分为观察组与对照组,每组各40例。对照组在分娩中应用罗哌卡因局部浸润麻醉,观察组在对照组基础上联合应用低剂量瑞芬太尼,观察两组初产妇各产程时间、中转剖宫产率及产后2h出血量,并采用视觉模拟评分法(VAS)评估麻醉前、麻醉后10min、麻醉后20min、麻醉后30min及宫口全开时两组初产妇的疼痛情况,同时观察两组分娩后不良反应发生情况。结果:观察组第一产程时间短于对照组,差异有统计学意义(P<0.05);两组第二产程、第三产程时间对比,差异无统计学意义(P>0.05);观察组中转剖宫产率及产后2h出血量均小于对照组,差异有统计学意义(P<0.05);两组麻醉前VAS评分对比,差异无统计学意义(P>0.05);麻醉后10min、麻醉后20min、麻醉后30min及宫口全开时观察组VAS评分均小于对照组,差异有统计学意义(P<0.05);两组分娩后不良反应发生率对比,差异无统计学意义(P>0.05)。结论:在初产妇分娩镇痛中应用低剂量瑞芬太尼联合罗哌卡因局部浸润可缩短第一产程时间,降低中转剖宫产率及产后出血量,并能够减轻初产妇疼痛感,且不会增加不良反应,安全性良好。

Objective:To investigate the analgesic effect of low dose remifentanil combined with ropivacaine in local infiltration anesthesia in primipara delivery.Methods:A total of 80 primiparas who delivered in Shishi Maternal and Child Health Hospital from January 2021 to December 2022 were selected as the study subjects.They were divided into observation group and control group using random number table method,with 40 primiparas in each group.The control group received local infiltration anesthesia with ropivacaine during delivery,while the observation group received low dose remifentanil combined with the control group.The duration of each stage of labor,the rate of conversion to cesarean section,and the amount of bleeding at 2h postpartum in the two groups of primipara were observed.The visual analogue scale(VAS)was used to assess the pain situation of the two groups of primipara before,10 minutes,20 minutes,30 minutes,and at the time of full uterine opening.The incidence of adverse reactions after delivery in the two groups was also observed.Results:The first stage of labor in the observation group was shorter than that in the control group,with a statistical significant difference(P<0.05).There was no statistical significant difference in the second and third stages of labor between the two groups(P>0.05).The rate of conversion to cesarean section and the amount of bleeding at 2 hours postpartum in the observation group were lower than those in the control group,with a statistical significant difference(P<0.05).There was no statistical significant difference in VAS scores between the two groups before anesthesia(P>0.05).The VAS scores in the observation group were significantly lower than those in the control group at 10 minutes,20 minutes,30 minutes,and total uterine opening,with a statistical significant difference(P<0.05).There was no statistical significant difference in the incidence of adverse reactions after delivery between the two groups(P>0.05).Conclusion:The application of low dose remifentanil combined with local infiltration of ropivacaine in labor analgesia for primipara can shorten the time of the first stage of labor,reduce the rate of conversion to cesarean section and postpartum hemorrhage,and reduce the pain sensation of primipara without increasing adverse reactions,with good safety.