摘要
目的比较瑞芬太尼静脉自控镇痛(PCIA)与罗哌卡因复合芬太尼腰-硬联合自控镇痛(CSEA)在分娩镇痛中的安全性和有效性。方法选择单胎足月初产妇60例,年龄22～32岁,身高156～170cm,体重60～75kg,ASAⅠ级,依据产妇自愿原则分为两组:瑞芬太尼静脉自控镇痛组(R组)和罗哌卡因复合芬太尼腰-硬联合自控镇痛组(E组),每组30例。R组瑞芬太尼背景剂量0.02μg·kg^(-1)·min^(-1),单次剂量10～20μg,锁定时间3min;E组蛛网膜下腔注射罗哌卡因2.5～3mg,然后连接硬膜外镇痛泵(0.1%罗哌卡因75ml+芬太尼2μg/ml),设置负荷剂量10ml,背景剂量8～10ml/h,单次剂量为5ml,锁定时间15min。记录产妇镇痛前、镇痛后30min的SBP、HR、SpO2;记录镇痛前、镇痛后30min和宫口开全时VAS疼痛评分、改良Bromage评分、Ramsay镇静评分;记录第一产程和第二产程时间、胎心率、新生儿Apgar评分及脐动脉血气;分析不良反应情况、产妇满意度。结果 R组VAS疼痛评分及Ramsay镇静评分明显高于E组(P<0.05);R组头晕发生率明显高于E组(P<0.05);两组产程时间、Bromage评分、恶心呕吐、嗜睡、皮肤瘙痒、尿潴留等不良反应情况、产妇满意度、胎心率、脐动脉血气分析及新生儿Apgar评分差异无统计学意义。结论与罗哌卡因复合芬太尼腰-硬联合自控镇痛比较,采用瑞芬太尼静脉自控镇痛有较好的镇痛效果。尽管产妇镇静深度更高,头晕发生率较多,但是对母婴无明显不良反应,可作为椎管内分娩镇痛的补充方法。
Objective To compare the analgesia effects and safety of remifentanilin patient controlled intravenous analgesia （PICA） combined with spinal-epidural analgesia（CSEA） with ropivacine and fentanyl.Methods Sixty full term primiparas who had a single fetus,aged 22-32 years,heighing 156-170 cm,weighing 60-75 kg,ASA physical statusⅠ,were randomly divided into two groups,30 cases in each.Patient controlled intravenous analgesia （PICA） used remifentanil （group R） and combined spinal-epidural analgesia （CSEA） ropivacine and fentanyl （group E）.Group R received PCIA of remifentanil（continuous background infusion of 0.02μg·kg^（-1）·min^（-1） and bolus doses of 10-20μg with 3 min lockout period）and group E were given intrathecal injection of ropivacaine 2.5-3.0 mg and additional patient controlled epidural analgesia when 75 ml mixture of 0.1% ropivacaine with 2μg/ml fentanil was put into the electric analgesia pump.The loading dose was 10 ml and the background infusion volume was 8-10 ml/h and the bolus volume was 5 ml with a lock-out interval 15 min.The lasting time of the first stage and the second stage,as well as the vital signs,VAS score,modified Bromage score,Ramsay sedation score,mode of delivery,the side effects of analgesia,degree of satisfaction of the primipara,fetal heart rate,umbilical artery blood-gas analysis and fetal Apgar scores were recorded.Results In group R,VAS score and Ramsay sedation score were higher than those in group E（P〈0.05）.The rate of dizziness was also higher than that in group E and the differences were statistically significant （P〈0.05）;There was no significant difference in vital signs,degree of satisfaction of the primipara,duration of the stage of labor,rate of cesarean section,modified Bromage score,side effects of analgesia except dizziness,fetal heart rate,umbilical artery blood-gas analysis and fetal Apgar scores.Conclusion Parturients controlled intravenous analgesia with remifentanil can provide a moderate degree of analgesia afforded by combined spinal-epidural analgesia with ropivacine and fentanyl.Although PCIA brings about deeper sedation and more case of dizziness,it has less side effects of analgesia for primipara and fetal.Therefore,PCIA can be used as a beneficial supplemental method for CSEA.
作者
朱爱兵
沈明坤
安舟引
姚飞
章文靖
李晓
ZHU Aibing;SHEN Mingkun;AN Zhouyin;YAO Fei;ZHANG Wenjing;LI Xiao(Department of Anesthesiology,the Affiliated Wuxi Maternity and Child Health Care Hospital of Nanjing Medical University,Wuxi 214002,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2018年第9期853-856,共4页
Journal of Clinical Anesthesiology
关键词
瑞芬太尼
患者自控静脉镇痛
腰-硬联合阻滞
分娩镇痛
Remifenumill Patient-controlled intravenous analgesia
Combined spinal-epidural analgesia
Labor analgesia
