瑞芬太尼静脉自控给药与硬脊膜外腔阻滞用于分娩镇痛的对比研究

Comparative study of labour analgesia with Intravenous remifentanil and epidural ropivacainewith fentanyl

目的探讨瑞芬太尼用于无痛分娩的镇痛效果及对整个产程的影响。方法孕38～42周健康初产妇70例,单胎头位,按镇痛方法分为静脉瑞芬太尼自控单次给药复合持续背景输注给药组(PCIA组)和硬脊膜外腔罗哌卡因复合芬太尼自控单次给药组(PCEA组),每组35例。PCIA组使用瑞芬太尼静脉自控镇痛,背景剂量为0.05μg·kg-1·min-1,单次剂量0.5μg/kg,锁定时间3min。PCEA组以2mg/mL罗哌卡因+2μg/mL芬太尼,首次剂量3mL,单次剂量5mL,锁定时间10min。宫口开全后两组均停药。分别在镇痛前,镇痛开始后5、10、20、30min,以及宫口开全时,应用疼痛视觉模拟评分(VAS评分,0分为无痛,10分为不能忍受的剧痛)评价宫缩痛情况。应用Ramsay镇静评分评价镇静情况。记录两组产妇的产程持续时间、新生儿1和10min Apgar评分、产科干预情况及药物不良反应。结果开始镇痛后,两组产妇的宫缩痛均迅速缓解,镇痛10min后直至宫口开全时,PCEA组的疼痛VAS评分均显著低于PCIA组(P值均<0.01)。PCIA组的第一、二产程均显著短于PCEA组(P值均<0.01)。两组间器械助产率、剖宫产率和催产素使用率的差异均无统计学意义(P值均>0.05)。两组新生儿1min Apgar评分为7分各1例,8分各1例,均为自然分娩;其余新生儿1min Apgar评分及所有新生儿10min Apgar评分均为10分。两组均无镇静过度和低氧血症发生。结论瑞芬太尼静脉自控给药用于分娩镇痛安全有效,可作为椎管内分娩镇痛的有效补充。目的探讨瑞芬太尼用于无痛分娩的镇痛效果及对整个产程的影响。方法孕38～42周健康初产妇70例,单胎头位,按镇痛方法分为静脉瑞芬太尼自控单次给药复合持续背景输注给药组(PCIA组)和硬脊膜外腔罗哌卡因复合芬太尼自控单次给药组(PCEA组),每组35例。PCIA组使用瑞芬太尼静脉自控镇痛,背景剂量为0.05μg·kg-1·min-1,单次剂量0.5μg/kg,锁定时间3min。PCEA组以2mg/mL罗哌卡因+2μg/mL芬太尼,首次剂量3mL,单次剂量5mL,锁定时间10min。宫口开全后两组均停药。分别在镇痛前,镇痛开始后5、10、20、30min,以及宫口开全时,应用疼痛视觉模拟评分(VAS评分,0分为无痛,10分为不能忍受的剧痛)评价宫缩痛情况。应用Ramsay镇静评分评价镇静情况。记录两组产妇的产程持续时间、新生儿1和10min Apgar评分、产科干预情况及药物不良反应。结果开始镇痛后,两组产妇的宫缩痛均迅速缓解,镇痛10min后直至宫口开全时,PCEA组的疼痛VAS评分均显著低于PCIA组(P值均<0.01)。PCIA组的第一、二产程均显著短于PCEA组(P值均<0.01)。两组间器械助产率、剖宫产率和催产素使用率的差异均无统计学意义(P值均>0.05)。两组新生儿1min Apgar评分为7分各1例,8分各1例,均为自然分娩;其余新生儿1min Apgar评分及所有新生儿10min Apgar评分均为10分。两组均无镇静过度和低氧血症发生。结论瑞芬太尼静脉自控给药用于分娩镇痛安全有效,可作为椎管内分娩镇痛的有效补充。

Objective To assess the effect of remifentanil in patient-controlled intravenous analgesia （PCIA） and its impact on each stage of labor. Methods Totally 70 healthy parturient at 38-42 weeks with singleton at head position were randomized to receive either patient controlled intravenous analgesia with remifentaniL （PCIA group） or patient controLLed epidural analgesia with robupivacaine plus fentanyL （PCEA group）, 35 cases in each group. PCIA group＇s background dose was 0.05μg·kg^-1·min^-1 with 0. 5 μg/kg bolus and 3 mins lock-out time. PCEA group was given 2 mg/mL robupivacaine combined with 2 μg/mL fentanyl and its initial dose was 3 mL with 5 mL as bolus and 10 mins lock-out time. Two groups stopped analgesia until cervix completely opened. Before analgesia, 5 min, 10 min, 20 min, 30 min after analgesia and cervix completely open, Visual analogue score （VAS, 0 means painless and 10 means intolerable pain） and Ramsay score （RSS） were used separately to evaluate the extent of patients＇ uterine contraction pain and sedation. Labor time, 1 min and 10 min Neonatal Aμgar score, the intervention of obstetrics and side effect of drug were recorded for each group, Results Uterine contraction pain was quickly relieved when given analgesia in both groups. VAS in PCEA group was lower than PCIA group from 10 rain after analgesia to cervix completely open （all P^0.01 ）. The labor time for first and second stage in PCIA group was shorter than PCEA group （both P^0.01 ）. There was no difference between two groups in the rate of instrumental delivery, cesarean section rate or oxytocin usage （all P~〉0. 05）. Each group had one neonatal 1 min Aμgar scored 7 points case and one 1 min Aμgar scored 8 with natural birth. The remaining neonatal 1 in Aμgar score and all newborns 10 min Aμgar scores we sedation or hypoxem effectively and safely 320-322〉 a in both . It is an groups. Conclusion Remifentanil with the m effective complement for POEA in labor analges re 10 points. There were no over ode of PCIA can ease labor pain ia.