摘要
目的探讨耳穴磁珠贴压联合瑞芬太尼PCIA分娩镇痛对产妇不同产程时的镇痛效果及其对母婴的影响。方法选择自愿要求分娩镇痛的产妇80例,随机分成瑞芬太尼镇痛组(R组,40例)和耳穴磁珠贴压联合瑞芬太尼镇痛组(ER组,40例)。选择同期拒绝行分娩镇痛的产妇作为对照组(C组,40例)。记录产妇宫口扩张1～2 cm(镇痛前,T0),宫口扩张1～2 cm(镇痛后,T1)、3～5 cm(T2)、6～8 cm(T3)、10 cm(宫口开全,T4)、分娩时(T5)以及胎盘娩出(T6)等7个时间点的VAS评分,产妇平均动脉压(MAP),心率(HR)以及胎心率(FHR)。记录产妇自控镇痛(PCA)按压次数,并计算瑞芬太尼的总用量。记录各产程时间、产妇不良反应情况、胎儿娩出后新生儿的Apgar评分和脐带血气分析结果。结果 15例产妇因中转剖宫产退出实验,其中C组5例,R组6例,ER组4例,共计105例产妇完成本研究。3组产妇年龄、身高、体质量、孕龄差异均无统计学意义(P> 0.05)。3组产妇在不同的时间点上的MAP,HR,FHR,各产程时间,总产程时间,产钳助产率,剖宫产率,胎儿娩出后1 min和5 min的Apgar评分,脐血pH值和BE值差异无统计学意义。3组产妇在T0的VAS评分均无明显差异。与T0相比,C组在T2-5的VAS评分明显升高,R组和ER组在T1-6的VAS评分明显降低。与C组相比,R组在T1-6的VAS评分明显降低。ER组在各时间点上的VAS评分和R组差异无统计学意义。R组头晕、恶心呕吐以及呼吸抑制的发生率与C组相比明显增高,ER组头晕和恶心呕吐发生率与R组相比明显下降,PCA按压次数和瑞芬太尼总用量明显降低。结论耳穴磁珠贴压联合瑞芬太尼分娩镇痛可有效缓解产妇在不同产程的产痛,且不良反应更少,值得在临床推广。
Objective To investigate labor analgesia effect of combination of magnetic beads auricular pressing therapy and remifentanil patient-controlled intra-venous analgesia(PCIA) on mother and baby.Methods 80 puerperants volunteered for labor analgesia were randomly divided into two groups:Group R(remi-fentanil only,n = 40)and Group ER(magnetic beads auricular pressing therapy combined with remifentanil,n = 40),and 40 puerperants who refused to receive labor analgesia were chosen as Group C(n = 40). VAS scores,MAP,HR and FHR were recorded on T0(before labor analgesia),T1(right after labor analgesia),T2(orifice of uterus is 3 ~ 5 cm wide),T3(orifice of uterus is 6 ~ 8 cm wide),T4(orifice of uterus is 10 cm wide),T5(laboring)and T6(placental expulsion). The pressing frequency of PCA,cumulated dosage of remifentanil,duration of labor,untow-ard effect,Apgar score and blood gas analysis of the newborn were recorded accordingly.Results 5 puerperantsin Group C,6 puerperants in Group R and 4 puerperants in Group ER were excluded from the study for cesareansection. No difference was found in ages,height,weight and gestational age among 3 groups. The MAP,HR andFHR at different time points,duration of labor,forceps delivery rate,cesarean section rate,Apgar score andblood gas analysis among 3 groups showed no difference. There was no significant different in the VAS score among 3 groups on T0. Compared with T0,VAS scores were higher on T2-5 in Group C while Group R and Group ER werelower. Compared with Group C,VAS scores were lower on T1-6 in Group R while no difference was found betweenGroup R and Group ER on any time point. The pressing frequency of PCA and cumulated dosage of remifentanilwere much lower in Group ER compared with Group R. Nausea and vomiting and respiratory depressionhappen more frequently in Group R than Group C,and less frequent in Group ER when compared with Group R.Conclusion The combination of magnetic beads auricular pressing therapy and remifentanil PCIA is effective in pain relief and less untoward effect during labor.
作者
文婷
李干
陈世彪
刘佳
WEN Ting;LI Gan;CHEN Shibiao;LIU Jia(The first affiliated hospital of Nanchang University,Nanchang 330006,China)
出处
《实用医学杂志》
CAS
北大核心
2018年第24期4162-4166,共5页
The Journal of Practical Medicine
基金
江西省卫生计生委科技计划(编号:20185116)
关键词
分娩镇痛
瑞芬太尼
耳穴磁珠
产程
APGAR评分
labor analgesia
remifentanil
magnetic beads auricular pressing therapy
labor
Apgar score
