瑞芬太尼静脉自控镇痛在分娩中的应用

Patient-controlled intravenous analgesia with remifentanil in labor

目的:探讨瑞芬太尼经静脉自控镇痛在分娩中的镇痛效果以及对产程及母婴的影响。方法:随机选择足月妊娠初产头先露,头盆评分≥7分,无妊娠合并症及并发症,自愿接受分娩镇痛的孕妇27例为实验组,进入产程后因宫缩疼痛需要进行疼痛干预时应用瑞芬太尼静脉电子微量泵给药行分娩镇痛。另随机选择同等条件的孕妇实行导乐分娩的孕妇30例为对照组,观察两组疼痛级别比较,呼吸循环指标,胎心电子监护,总产程及第一、第二、第三产程时间,催产素使用及器械助产率、剖宫产率、产后出血率、新生儿Apgar评分等指标。结果:实验组疼痛评定级别为优(0级)13例,良(1级)12例,一般(2级)2例,差(3级)0例。对照组疼痛评定级别为优(0级)0例,良(1级)3例,一般(2级)12例,差(3级)15例,两组比较实验组镇痛满意度显著高于对照组(P<0.01),两组比较总产程、第Ⅰ、第Ⅱ、第Ⅲ产程时间、催产素使用率、剖宫产率比较差异无统计学意义,两组均无产后出血,无器械助产,无胎儿窘迫及新生儿窒息,无孕妇呼吸循环抑制及低氧血症发生。结论:瑞芬太尼静脉自控镇痛用于分娩镇痛安全有效。

Objective：To assess the safety and analgesic activity of remifentanil in patient-controlled intravenous analgesia （PCIA） during labor. Methods：27 full term pregnant women were selected at random as experimental group and received PCIA with remifentanil by electronic pump. 30 full term pregnant women with Doula were selected at random as control group. To observe and contrast the indi- cators of the two groups in pain rating,cycle,fetal electronic monitoring,length of total,first,second,third stage of labor,application of oxytocin and obstetric apparatus,cesarean rate,rate of PPH and neonate Apgar score. Results：The experimental group pain rating as- sessed levels： level 0 （excellent） 13 cases,level 1 （good） 12 cases,level 2 （ordinary） 1 case,level 3 （bad） 0 case. The control group pain rating assessed levels： level 0（excellent）0 case,level 1 （good） 3 cases,level 2（ordinary） 12 cases,level 3（bad） 15 cases. The analgesic satisfaction of the experimental group was significantly higher than that of the control group （P〈0.01）. The length of total,first,second, third stage of labor,application of oxytocin and obstetric apparatus,cesarean rate between the two groups had no statistical difference. There were no PPH, application of obstetric apparatus,fetal distress,neonatal asphyxia and hypoxemia in the two groups. Conclusion： Remifentanil with the mode of PCIA can ease labor pain effectively and safety.