摘要
目的评价瑞芬太尼静脉镇痛在分娩镇痛中的效果及安全性。方法选择ASAⅠ、足月妊娠单胎初产妇100例,根据产妇自愿随机分为2组（n=50）,观察组首次静注瑞芬太尼20μg,再连接含30μg/m L瑞芬太尼静脉镇痛泵,予6 m L/h匀速泵入（根据疼痛情况调整速度8 m L/h）;对照组先蛛网膜下腔予布比卡因1.5 mg＋芬太尼20μg（0.4 m L）后,再连接含0.1%布比卡因复合10μg/m L芬太尼混合液硬膜外镇痛泵,予6 m L/h匀速泵入（根据疼痛情况调整速度8 m L/h）;测定产妇VAS评分、记录产妇的各个产程时间,催产素使用情况、分娩方式、产后2 h内出血量,新生儿Apgar评分、以及母体和新生儿不良反应,分析分娩镇痛后的患者满意度。结果 2组器械助产、瘙痒、尿潴留、低氧血症发生率及新生儿Apgar评分均相似;观察组镇痛后各个时点（T1~T4）的VAS评分分别为（3.06±1.00）、（3.68±0.77）、（3.94±0.65）和（4.48±0.71）,均高于对照组的（1.68±1.19）（1.72±0.97）（1.86±0.99）（2.08±0.84）,而2组的患者满意度差别无统计学意义;观察组的第一产程和第二产程时间分别为（495.87±147.96）min和（42.21±19.40）min,对照组分别是（589.92±187.02）min和（56.30±37.75）min,观察组均较对照组短（P〈0.05）;观察组的催产素使用和剖宫产率、呕吐、下肢麻木及低血压发生率分别为50%、6%、4%、0%和0%,均低于对照组的90%、26%、18%、10%和8%（P〈0.05）,而头晕发生率达70%,高于对照组的4%（P〈0.01）。结论瑞芬太尼静脉镇痛操作简单,缩短产程,具有椎管镇痛同等的患者满意度。
Objective To compare the efficacy and safety between intravenous analgesia with remifentanial （experimental group） and neuraxial analgesia with bupivacaine/fentanil in labor（control group）. Methods 100 full term primigravidas with a single and ASA I were divided into two groups（Experimental group and control group）, with 50 primigravidas in each group according to their choice for labor analgesia. Experimental group intravenously received 20 μg remifentanial as the loading dose, and then connected with the intravenous analgesic pump with remifentanial 30 μg/ mL; Control group intrathecally received 20 μg fentanil and 1.5 mg bupivacaine as the loading dose and then connected with the epidural analgesic pump with 0.125% bupivacaine and fentanial 1 μg/mL. The analgesic pump was set in the two groups as follows： continuous perfusion rate 6 mL/h （depending on the pain relief adjusting speeds to 8 mL/h）, total volume 60 mL. Pain intensity was assessed with visual analog scale （VAS）. The labour course of first, second and third stage, the use of oxytocin, delivery mode, Apgar scors of the neonate were recorded. Side effects during labour and postpartum such as dizzy, vomiting, hypotention, hypoxemia also recorded. Patient satisfaction recorded respectively. Results Inthe eperimental group VAST T1- T4 were （3.06±1.00）, （3.68±0.77）, （3.94±0.65） and （4.48±0.71）, the control group were（1.68±1.19） （1.72±0.97）（1.86±0.99） and （2.08~0.84）, eperimental group displayed higher pain intensity than that of the control group （P〈0.01）, but the patients＇ satisfaction rates in experimental group were no significant difference The course of first and second stage of labor in experimental group were （495.87±147.96）min and（42.21± 19.40 ）min, it in the control group were （589.92±187.02）min and （56.30±37.75）min, The course of first and second stage of labor in eperimental group were shorter than control group （P〈0.05）; The rates of cesarean delivery, the use of oxytocin, and the incidences of vomiting, leg numbness, hypotension in experimental group were 50%, 6%, 4%, 0% and 0%, the control group was 90%, 26%, 18%, 10% and 8%, respectively, experimental group was lower than control group （P〈0.05）, but the incidences of dizzy in experimental group were 70%, experimental group was higher than control group （P〈0.01）. Conclusion In labor analgesia, intravenous analgesia with remifentanial is simple to operate and can reduce the duration of labor time; As for patients＇ satisfaction rates, intravenous analgesia with remifentanial may be comparable to neuraxial analgesia with bupivacaine/fentanil in labor analgesia.
出处
《当代医学》
2015年第32期9-11,共3页
Contemporary Medicine
关键词
瑞芬太尼
分娩镇痛
静脉镇痛
硬膜外镇痛
Remifentanil
Labour analgesia
Intravascular analgesia
Neuraxial analgesia
