摘要
目的探讨瑞芬太尼静脉患者自控镇痛(PCIA)对产妇的镇痛效果及对泌乳素和应激反应的影响。方法选取2015年7月至2016年10月海南现代妇婴医院收治的产妇118例为研究对象,根据术中麻醉方式不同将产妇分为试验组和对照组,各59例。对照组在分娩时进行硬膜外患者自控镇痛(PCEA),试验组在分娩时采用瑞芬太尼PCIA。采用视觉模拟评分法(VAS)评定两组产妇的镇痛效果;比较两组产妇产程及新生儿Apgar评分,产妇泌乳素(PRL)、应激相关激素水平以及分娩镇痛期间的不良事件发生情况。结果从镇痛后10 min到宫口全开,两组VAS评分呈逐渐降低趋势,但组间差异无统计学意义(P>0.05)。试验组第一产程、第二产程时间均明显短于对照组[(435.52±62.68)min比(506.34±59.37)min、(40.59±6.94)min比(59.62±7.91)min](P<0.05)。两组PRL自分娩后30 min即显著升高,分娩后48 h达峰值,在同时相点试验组PRL显著高于对照组。分娩后,试验组肾上腺皮质激素、皮质醇、去甲肾上腺素及肾上腺素均显著低于对照组[(36.38±4.17)pmol/L比(45.65±4.38)pmol/L、(684.42±59.37)nmol/L比(742.68±62.37)nmol/L、(419.28±16.72)ng/L比(466.31±17.24)ng/L、(49.18±6.54)ng/L比(65.35±6.63)ng/L](P<0.01)。两组镇痛期间均有4例出现轻度恶心、呕吐,经对症治疗后缓解,未见其他不良事件发生。结论 PCEA和瑞芬太尼PCIA均可减轻产妇疼痛程度,对新生儿和产妇均无不良影响,且瑞芬太尼PCIA可缩短产程、减轻应激反应、提高泌乳量,因而更为安全有效。
Objective To investigate the analgesic effect of remifentanil patient-controlled intravenous analgesia（ PCIA） on stress levels and prolactin levels in puerpera. Methods A total of 118 pregnant women were selected from Hainan Modern Maternity and Infant Hospital during Jul. 2015 and Oct. 2016,and divided into a trial group and a control group according to the mode of anesthesia during operation,59 cases each. The control group was treated with patient-controlled epidural analgesia（ PCEA） during childbirth,while the trial group was treated with remifentanil PCIA during childbirth,and visual analogue scale（ VAS） assessment of maternal analgesia was used in both groups; the maternal labor and neonatal Apgar score,maternal prolactin（ PRL） and the change of stress hormone levels,and the adverse reactions during labor analgesia of the two groups were compared. Results From 10 min after analgesia to the complete cervix open,VAS scores of both groups decreased gradually,but there was no significant difference between the two groups; the first stage and second stage of labor of the trial group was（ 435. 52 ± 62. 68） min,（ 40. 59 ± 6. 94） min,shorter than the control group＇s[（ 506. 34 ± 59. 37） min,（ 59. 62 ± 7. 91） min]（ P 〈0. 05）. From 30 min after delivery to 48 h,the PRL levels of both groups gradually increased,and the trial group was higher than the control group at the same time points. The levels of adrenocorticotropic hormone,cortisol,norepinephrine and adrenal hormone in the trial group after delivery were significantly lower than those of the control group [（ 36. 38 ± 4. 17） pmol/L vs（ 45. 65 ± 4. 38） pmol/L,（ 684. 42 ± 59. 37） nmol/L vs（ 742. 68 ± 62. 37） nmol/L,（ 419. 28 ± 16. 72） ng/L vs（ 466. 31 ± 17. 24） ng/L,（ 49. 18 ± 6. 54） ng/L vs（ 65. 35 ±6. 63） ng/L]（ P〈 0. 01）. During the analgesia,mild nausea and vomiting occurred in 4 patients in each group,and all were relieved after symptomatic treatment. No other adverse eve
作者
许伟坚
王君灵
劳加锦
XU Weijian;FANG Junling;LAO Jiajin(Department of Anesthesiology, Hainan Modern Maternity and Infant Hospital, Haikou 570206, Chin)
出处
《医学综述》
2018年第9期1864-1868,共5页
Medical Recapitulate
关键词
瑞芬太尼
镇痛
产妇
应激
泌乳量
Remifentanil
Analgesia
Puerpera
Stress
Lactation yield
