瑞芬太尼用于静脉自控分娩镇痛对产妇、胎儿及新生儿的影响

Effects of remifentanil patient-controlled intravenous analgesia on maternity,foetus and neonatal in labour

目的：通过瑞芬太尼静脉自控分娩镇痛与硬膜外镇痛、自然分娩的对比研究,探讨瑞芬太尼对产妇镇痛效果、胎儿及新生儿的影响。方法：60例足月产妇随机分为瑞芬太尼静脉镇痛组（A组）、硬膜外镇痛组（B组）和自然分娩对照组（C组）,每组20例。正规宫缩建立后,A组静脉瑞芬太尼首次剂量10-20μg,背景剂量0.05μg·kg-1·min-1,病人自控镇痛（PCA）剂量0.25μg·kg-1,锁定时间2 min;B组硬膜外5 ml负荷量,持续注入0.1%罗哌卡因＋0.000 2%芬太尼,背景剂量为6 ml·h-1,快速给药剂量设为2 ml,锁定时间为15 min;C组采用自然分娩常规产科处理。记录产妇不同时点的视觉模拟评分（VAS）、产程、出血量、泌乳时间和不良反应,胎儿脐动脉血气分析,新生儿Apgar评分、神经和适应能力评分（NACS）。结果：随着产程的进展,A组VAS评分要明显高于B组（P〈0.05）,C组的第1产程活跃期时间较A、B组明显延长（P〈0.05）,产妇出血量及泌乳时间、新生儿Apgar评分、胎儿脐动脉血气值及NACS评分3组间比较无统计学意义,但A组不良反应明显多于B组（P〈0.05）。结论：瑞芬太尼静脉分娩镇痛较硬膜外镇痛效果差且不良反应多,但对新生儿影响无明显差异,对于不愿或椎管内镇痛有禁忌的产妇,可用瑞芬太尼静脉镇痛。

Objective： To investigate the effect of remifentanil in patient controlled intravenous analgesia（ PCIA）on maternity,foetus and neonatal in labour by comparing with epidural analgesia and spontaneous labor. Methods：Sixty full-term pregnant women were randomized to three groups at active phase. Group A intravenously received25 μg remifentanil as the loading dose and then connected with electronic intravenous analgesia pump,there were0. 05 μg·kg-1·min-1background dose and 2 min lock-out time. Group B epidurally received 5 ml of liquids mixed with 0. 1% ropivacaine and 0. 000 2% fentanyl as the loading dose and then connected with electronic epidural analgesia pump,there were 6 ml·h-1background infusion and 15 min lock-out time. Group C didn’t use medicine to ease the pain. Visual analogue score（ VAS）,birth process,volume of hemorrhage,milk secretion,adverse effect,the Apgar score,blood gas analysis of foetal umbilical artery,neonatal nerval and adaptive capacity score（ NACS） were recorded. Results： Along with progress of birth process,VAS was obviously higher in group A than that of group B（ P 〈 0. 05）. Active stage was obviously longer in group C than in group A and group B in first birth process（ P 〈 0. 05）. The volume of hemorrhage,the Apgar score,blood gas analysis of foetal umbilical artery,milk secretion and NACS had no difference in statistics（ P 〉 0. 05）. The adverse effect was obviously more in group A than in group B（ P 〈 0. 05）. Conclusion： Comparing with epidural analgesia,PCIA with remifentanil has baddish effect major adverse effect,has no effect on neonatus. The puerperal who refuse epidural analgesia and has contraindication of epidural analgesia can be given PCIA with remifentanil.