瑞芬太尼分娩镇痛对子痫前期产妇血清一氧化氮的影响

李秀满 周宪 田林生 佘定琼 王卫民

[摘要] 目的 研究瑞芬太尼分娩鎮痛对子痫前期产妇的镇痛效果及对胎盘循环的影响。 方法 选择2018年1月至2019年12月在怀化市妇幼保健院自愿接受分娩镇痛的子痫前期产妇100例，随机分为两组，瑞芬太尼组（R组，n=50）和硬膜外组（E组，n=50），测定脐动脉血气指标，分别在镇痛前（T0）、镇痛后2 h（T1）采肘静脉血，胎盘娩出时（T2）采脐动脉血，采用硝酸还原酶法测定一氧化氮（NO）水平;记录两组不同时点的SBP、HR、RR、SpO2、VAS评分及Ramsay镇静评分，记录两组总产程时间和分娩方式，不良反应例数，新生儿1、5 min Apgar评分;分析满意度调查结果。 结果 两组镇痛后各个时点（T1～T2）的VAS评分均低于T0，差异有统计学意义（P<0.05），其中R组镇痛后各个时点（T1～T2）的VAS评分和Ramsay镇静评分均高于E组，差异有统计学意义（P<0.05），两组患者满意评分比较，差异无统计学意义（P>0.05）;两组产妇镇痛后2 h（T1）和胎盘娩出时（T2）脐血NO浓度均高于处理前（T0），差异有统计学意义（P<0.05），两组间比较，差异无统计学意义（P>0.05）;R组各时点Apgar评分与E组比较，差异无统计学意义（P>0.05），R组的总产程时间明显短于E组，差异有统计学意义（P<0.05）;两组不同时间点的SBP、HR、RR和SpO2比较，差异均无统计学意义（P>0.05）;R组有15例出现眩晕，E组有5例，差异有统计学意义（P<0.05），两组其他不良反应发生率比较，差异无统计学意义（P>0.05）。 结论 瑞芬太尼静脉分娩镇痛对子痫前期产妇镇痛效果较好，升高NO水平对胎盘循环有利。

[关键词] 瑞芬太尼;分娩镇痛;产前子痫;一氧化氮

[中图分类号] R614.4          [文献标识码] B          [文章编号] 1673-9701（2021）31-0067-04

[Abstract] Objective To study the analgesic effect of remifentanil for labor analgesia on parturients with preeclampsia and its influence on placental circulation. Methods A total of 100 parturients with preeclampsia who voluntarily received labor analgesia in Huaihua City Maternal and Child Health Care Hospital from January 2018 to December 2019 were selected and randomly divided into the remifentanil group （group R， n=50） and the epidural group （group E， n=50）. Umbilical artery blood gas was measured. Cubital venous blood was collected before analgesia（T0） and 2 hours after analgesia （T1）. The umbilical artery blood was collected at delivery of the placenta （T2）. Nitric oxide （NO） level was measured by the nitrate reductase method. SBP HR， RR， SpO2， VAS scores， and Ramsay sedation score were recorded at different time points in the two groups. The total labor time and mode of delivery， number of adverse reactions， and Apgar scores at 1 and 5 minutes of newborns were recorded in both groups. Satisfaction survey results were analyzed. Results The VAS scores at various time points after analgesia （T1-T2） were lower than T0 in both groups， the difference was statistically significant （P<0.05）. The VAS scores and Ramsay sedation scores at various time points after analgesia （T1-T2） in group R were higher than those of group E， the difference was statistically significant （P<0.05）. There was no significant difference in patient satisfaction score between the two groups（P>0.05）. The cord blood NO concentrations at 2 hours after analgesia （T1） and delivery of the placenta （T2） in the two groups were higher than those before treatment （T0） ，the difference was statistically significant （P<0.05）. There was no significant difference between the two groups（P>0.05）. The Apgar scores at each time point in group R were not significantly different from those in group E（P>0.05）， and the total labor time in group R was significantly different from that in group E，the difference was statistically significant（P<0.05）. There was no significant difference in SBP， HR， RR， and SpO2 at different time points between the two groups（P>0.05）. There are 15 cases of vertigo in group R and 5 cases in group E， and the difference was statistically significant （P<0.05）. There was no significant difference in the incidence of other adverse reactions between the two groups（P>0.05）. Conclusion Intravenous remifentanil for labor analgesia has a good analgesic effect on parturients with preeclampsia， and increased NO level is beneficial to placental circulation.

[Key words] Remifentanil; Labor analgesia; Prenatal eclampsia; Nitric oxide

子痫前期（Preeclampsia，PE）临床多表现为高血压、蛋白尿和水肿，PE产妇在分娩过程中有可能导致子痫或心脑血管意外，因此维持整个分娩过程中循环的平稳尤其重要，恰当地实施分娩镇痛，可有效降低血压，对子痫前期产妇有益[1]。……