Effect of administration mode and time of remifentanil patient-controlled intravenous analgesia on parturient women and fetuses/newborns
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摘要:
目的 观察瑞芬太尼静脉自控给药模式和时机对产妇、胎儿/新生儿的影响。 方法 将患者随机分为观察组（80例）及对照组（45例）。观察组使用瑞芬太尼静脉自控分娩镇痛，对照组为产科常规处理。将观察组产妇随机分成4组： A1组为间歇静脉自控给药、A2组为持续输注复合间歇静脉自控给药、B1组为潜伏期分娩镇痛、B2组为活跃期分娩镇痛，每组20例。观测VAS评分、PCA按压次数、缩宫素使用情况、器械助产率、产后2 h出血量及分血浆泌乳素浓度、分娩镇痛并发症、产后并发症等不良反应，评估新生儿Apgar评分、血气及呼吸频率。 结果 观察组和对照组在产程时间、2 h出血量、分娩新生儿1 min、5 min Apgar评分、动脉血气、呼吸频率、收缩压、心率差异均无统计学意义（P>0.05）。与对照组比较，观察组VAS评分降低、泌乳素浓度增加（P<0.05），而助产、剖宫产例数及缩宫素使用例数明显较少（P<0.05），A2组VAS评分与PCA按压次数低于A1组，B1组低于与B2组，差异均具有统计学意义（P<0.05）。A2组泌乳素浓度高于A1组，B1组高于B2组（P<0.05）。 结论 持续输注复合间歇静脉自控给药和潜伏期镇痛效果更优，能够促进泌乳素分泌，同时可减少PCA按压次数，对产妇及新生儿无明显不良影响。 Abstract:Objective To observe the effect of administration mode and time of remifentanil patient-controlled intravenous analgesia on parturient women and fetuses/newborns. Methods Patients were randomly divided into observation group (n=80) and control group (n=45). The observation group received remifentanil intravenous analgesia, while the control group received routine obstetric treatment. The observation group were further divided into four groups randomly, with 20 cases in each group. A1 group was given intermittent patient-controlled intravenous analgesia, A2 group was given continuous infusion combined with intermittent intravenous self-administration, B1 group received analgesia during the incubation period and B2 group during the active period. VAS score, number of PCA compression, oxytocin use, instrumental delivery rate, postpartum hemorrhage at 2h, plasma prolactin concentration, labor complications of postpartum analgesia, postpartum complications and other adverse reactions were observed. Results There was no significant difference in the general clinical data between the groups at admission (P>0.05). There was no statistical difference in Apgar score, labor time, hemorrhage at 2h, neonatal Apgar scores at 1min and 5min, arterial blood gas, respiratory rate, contraction pressure and heart rate between the observation and control groups (P>0.05). Compared with control group, VAS score of observation group was significantly reduced, prolactin concentration was significantly increased, while the number of midwifery, cesarean section cases, and oxytocin use cases were significantly less (P<0.05). The VAS score and PCA compression of A2 group were significantly lower than those of A1 group, and those of B1 group were lower than those of B2 group, with all differences being significant (P<0.05). Prolactin concentrations in group A2 were higher than those in group A1, and those in group B1 were higher than those in group B2. Conclusion Continuous infusion combined with intermittent intravenous self-administration analgesia can perform better analgesic effect during incubation period, promote the secretion of prolactin, and reduce the number of PCA compressions, while producing no obvious adverse effects on parturient women and newborns. -
Key words:
- remifentanil /
- delivery pain /
- dosage mode /
- administration time
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表 1 两组一般临床资料比较（Mean±SD）
指标 观察组 对照组 P 年龄（岁） 22.5±2.43 23.61±2.81 0.321 孕周（周） 39.3±1.3 39.9±0.8 0.542 孕次（次） 1.3±0.2 1.1±0.4 0.481 体质量指数（kg/m2） 25.2±2.12 26.3±1.84 0.301 收缩压（mmHg） 118.4±8.7 123.2±10.9 0.182 舒张压（mmHg） 75.8±6.8 78.2±7.1 0.131 心率（次/min） 83.1±10.2 85.2±12.1 0.151 体温（℃） 36.3±0.5 36.8±0.3 0.503 
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表 2 疼痛评分比较（Mean±SD，分）
组别 例数 镇痛开始时 5 min 20 min 60 min 宫口全开 A1 20 9.32±1.34 6.34±1.02# 3.76±0.63# 4.51±0.79# 5.41±0.97# A2 20 9.21±1.41 4.51±0.87#* 2.02±0.46#* 3.65±0.72#* 4.65±0.92#* B1 20 9.47±1.28 4.71±0.93#* 1.93±0.48#& 3.41±0.67#& 4.43±0.78#& B2 20 9.36±1.38 6.13±1.12# 3.63±0.71# 4.42±0.83# 5.56±0.89# 对照组 45 9.31±1.31 - - - 9.09±1.43 # t=3.328, P<0.05vs对照组; *t=2.248, P<0.05 vs A1组;& t=2.561, P<0.05vsB2组 ; - : 未测.
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表 3 产程时间、分娩方式比较
组别 例数 第1产程
（Mean±SD，min）第2产程
（Mean±SD，min）第3产程
（Mean±SD，min）分娩方式（例） 缩宫素使用（例） 自然分娩 助产 剖宫产 A1 20 571.34±132.23 45.31±12.43 9.32±3.21 16 3 1 12 A2 20 607.87±152.21 40.49±10.38 10.43±2.93 17 2 1 13 B1 20 589.43±145.28 43.12±9.61 8.74±3.94 16 2 2 13 B2 20 596.74±138.96 39.48±11.43 9.81±3.01 18 1 1 14 对照组 45 608.31±154.81 43.65±10.76 11.31±3.65 8 6 6 37 χ2 0.121 0.124 0.112 12.341 10.721 P 0.219 0.231 0.181 0.026 0.029
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表 4 PCA按压次数、产后2 h出血量、血浆泌乳素比较（Mean±SD）
组别 例数 PCA按压（次） 产后2 h出血量（mL） 泌乳素（μg/L） A1 20 5.31±1.31 201.23±65.11 271.21±13.51# A2 20 4.48±1.02* 221.41±59.23 312.21±13.25#* B1 20 5.01±1.25 213.43±67.21 309.32±11.39# B2 20 5.51±1.37 229.31±79.32 276.71±13.93& 对照组 45 5.25±1.28 215.43±65.54 245.21±12.54 # t=2.871, P<0.05vs对照组; *t=3.021, P<0.05vsA1组; &t=2.761, P<0.05vsB2组.
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表 5 新生儿结局比较
组别 例数 Apgar评分（≤7分） pH（Mean±SD，mmHg） PCO2
（Mean±SD，mmHg）PO2
（Mean±SD，mmHg）呼吸频率
（Mean±SD，次/min）出生后1 min 出生后5 min A1 20 6 2 7.31±0.31 48.47±6.32 23.41±5.21 37.48±2.31 A2 20 5 1 7.28±0.29 46.31±8.97 19.47±4.86 36.87±3.02 B1 20 6 1 7.29±0.35 50.31±7.43 22.95±4.17 37.56±4.32 B2 20 5 2 7.25±0.42 45.87±9.39 21.52±4.57 37.98±3.64 对照组 45 6 1 7.30±0.36 47.49±8.10 20.62±4.41 38.91±4.61 χ2 0.151 0.892 - - - P 0.457 0831 0.365 0.154 0.221 0.431
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