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目的观察瑞芬太尼静脉自控给药联合导乐仪用于产妇分娩镇痛的效果,探讨联合镇痛模式对产妇分娩镇痛的有效性与安全性。方法选择2016年3月至2017年3月160例预行阴道分娩的产妇,随机分成为对照组(A组),实施常规分娩;导乐仪组(B组),采用导乐仪镇痛;瑞芬太尼组(C组),用瑞芬太尼浓度为10μg/ml,团注剂量0.3μg/kg,锁定时间为2 min的方法镇痛;瑞芬太尼与导乐仪联合组(D组),在采用C组镇痛方式的同时复合导乐仪镇痛;每组40例。观察镇痛前、镇痛后10、30、60 min、宫口开全、娩出时视觉模拟评分(VAS),记录第一、二、三产程时间,记录剖宫产例数、产妇出血量及新生儿1、5 min的Apgar评分,记录瑞芬太尼用量及患者自控镇痛(PCIA)的有效按压率(有效按压次数与总按压次数比),记录产妇分娩镇痛期间不良反应发生率。结果 B、C、D三组产妇在镇痛后各时间点VAS评分均减小,与A组比较差异有统计学意义(P均<0.05),且D组产妇在镇痛后各时间点VAS评分均小于B、C组,差异有统计学意义(P均<0.05);C、D两组产妇第一产程时间减少,与A、B组比较差异有统计学意义(P均<0.05);且D组产妇第一产程时间低于C组,差异有统计学意义(P<0.05);D组的剖宫产率下降明显,与A组比较差异有统计学意义(P<0.05)。四组产妇出血量及新生儿Apgar评分比较差异无统计学意义(P均>0.05)。与C组比较,D组瑞芬太尼用量明显减少,有效按压率升高,总不良反应发生率降低,差异有统计学意义(P均<0.05)。结论瑞芬太尼静脉自控镇痛联合导乐仪用于分娩镇痛能提供良好镇痛效果,有效缩短产妇第一产程时间,可降低剖宫产率和不良反应的发生。
Objective To observe the effect of remifentanil self-administered intravenous catheter and guide instrument on maternal labor analgesia, and to explore the efficacy and safety of the combined analgesia model on labor analgesia. Methods 160 cases of vaginal delivery from March 2016 to March 2017 were randomly divided into control group (group A) and routine delivery. Guiding instrument group (group B) Remifentanil group (group C), with remifentanil concentration of 10μg / ml, bolus dose of 0.3μg / kg, locking time of 2min analgesia; remifentanil and lead instrument joint group ( D group), analgesia in the use of C group analgesia compound guide music analgesia; 40 cases in each group. Visual analgesia scores (VAS) at 10, 30, and 60 min after cervicitis and before delivery were recorded. The time of first delivery, second and third births were recorded. The number of cesarean section, maternal bleeding, The 1,5-minute Apgar score of newborns recorded the effective amount of remifentanil (PCIA) and the effective compression rate (the number of effective pressure and the total number of compression), recorded the incidence of adverse reactions during labor analgesia. Results The VAS scores of B, C and D groups decreased at each time point after analgesia, and there was significant difference compared with A group (all P <0.05) The difference was statistically significant (P <0.05). The time of the first stage of labor was decreased in both groups (P <0.05). The difference was statistically significant (P <0.05). The time of the first stage of labor in group D was lower than that of group C, the difference was statistically significant (P <0.05). The rate of cesarean section in group D decreased significantly compared with group A (P <0.05). Four groups of maternal bleeding and neonatal Apgar score difference was not statistically significant (P all> 0.05). Compared with group C, the dosage of remifentanil in group D decreased significantly, the effective compression rate increased, the total adverse reaction rate decreased, the difference was statistically significant (all P <0.05). Conclusion The combination of remifentanil intravenous controlled analgesia with the guided instrument can provide good analgesia for labor analgesia, effectively shorten the time of first delivery and reduce the incidence of cesarean section and adverse reactions.