瑞芬太尼PCIA在分娩镇痛的应用

Application of remifentanil PCIA in labor analgesia

目的通过与腰硬联合麻醉(CSEA)后自控镇痛法比较,探讨瑞芬太尼自控静脉镇痛法(PCIA)应用于分娩镇痛的有效性和安全性。方法初产妇105例,随机分为A组、B组与对照组,各35例。对照组未行分娩镇痛;A组给予蛛网膜下腔注射舒芬太尼5μg,然后连接硬膜外镇痛泵;B组给予静脉注射25μg负荷量的瑞芬太尼,然后连接静脉电子镇痛泵。观察三组产妇视觉模拟评分(VAS)、产程时间、分娩方式、新生儿Apgar评分及脐动脉血气、不良反应。结果镇痛后,A、B组VAS评分下降,与对照组比较差异有统计学意义(P<0.01),A、B组间差异无统计学意义(P>0.05)。A、B两组新生儿Apgar评分、脐动脉血气比较差异无统计学意义(P>0.05)。A组第二产程时间延长,组间差异有统计学意义(P<0.05),B组在过度镇静和呼吸抑制上明显多于A组,组间差异有统计学意义(P<0.05)。结论瑞芬太尼PCIA镇痛效果比CSEA-自控硬膜外镇痛(PCEA)稍差,但仍能提供有效镇痛效果,操作简单无创,对产程和胎儿无不良影响,作为产妇拒绝或禁忌腰硬联合麻醉的替代手段,值得进一步探讨推广。

ObjectiveTo investigate effectiveness and safety of remifentanil patient controlled intravenous analgesia （PCIA） applied in labor analgesia, by comparing with patient controlled intravenous analgesia after combined spinal epidural anesthesia （CSEA）. MethodsA total of 105 primipara were randomly divided into group A, group B and control group, with 35 cases in each group. The control group received no labor analgesia. Group A received 5μg of remifentanil by subarachnoid injection and connection with epidural analgesia pump. Group B received 25μg of remifentanil by intravenous injection and connection with intravenous electronic analgesia pump. Observations were made on visual analogue scale （VAS） scores, labor time, delivery ways, neonatal Apgar score, umbilical arterial blood gas, and adverse reactions in the three groups. ResultsAfter analgesia, groups A and B had reduced VAS scores, and their difference with the control group had statistical significance （P〈0.01）. The difference between groups A and B had no statistical significance （P〉0.05）. There was no statistically significant difference of neonatal Apgar score and umbilical arterial blood gas between groups A and B （P〉0.05）. Group A had prolonged time in the second labor stage, and the difference had statistical significance （P〈0.05）. Group B had much more excessive sedation and respiratory depression than group A, and their difference had statistical significance （P〈0.05）.ConclusionRemifentanil PCIA provides slightly worse analgesia effect than CSEA-patient controlled epidural analgesia （PCEA）, while it can still provide effective analgesia effect and simply non-invasive operation, without adverse influence on labor stage and fetus. As an alternative measure for puerpera who refuse or have no indication for combined spinal epidural anesthesia, this method is worthy of further promotion and application.