蛛网膜下腔阻滞联合瑞芬太尼PCIA在分娩镇痛中的应用

Application of Subarachnoid Block combined with Remifentanil PCIA in Labor Analgesia

目的:探讨蛛网膜下腔阻滞联合瑞芬太尼病人自控静脉镇痛(PCIA)分娩镇痛的效果和不良反应。方法:拟经阴道分娩并自愿选择分娩镇痛的初产妇85例,随机分入持续硬膜外阻滞组(A组,n=28);蛛网膜下腔阻滞联合瑞芬太尼PCIA组(B组,n=29);瑞芬太尼PCIA组(C组,n=28)。记录患者一般情况、镇痛起效时间、镇痛开始后10、15、30、60和90min的VAS评分、镇痛效果、Bromage评分、各产程时间、胎儿窘迫和新生儿窒息发生率、产后出血量、缩宫素使用率、中转剖宫产率及不良反应。结果:C组镇痛起效快于A组和B组(P<0.01)。镇痛开始后10、15和30min B组VAS评分低于A组和C组(P<0.01),镇痛开始后60、90min B组VAS评分与A组比较差异无统计学意义(P>0.05),显著低于C组(P<0.01)。A组和B组镇痛效果优于C组(P<0.05),A、B两组间镇痛效果比较差异无统计学意义(P>0.05)。三组患者Bromage评分比较差异无统计学意义(P>0.05)。A组第一产程和第二产程均长于B组和C组(P<0.05),A组缩宫素使用率高于B组和C组(P<0.01),B、C两组间第一产程、第二产程和缩宫素使用率比较均差异无统计学意义(P>0.05)。三组产后出血量、中转剖宫产率、胎儿和新生儿窒息发生率比较差异均无统计学意义(P>0.05)。C组头晕、恶心呕吐发生率高于A组和B组(P<0.05)。结论:蛛网膜下腔阻滞联合瑞芬太尼PCIA用于分娩镇痛效果确切、对产程和分娩结局无不良影响,不增加不良反应,可安全应用。

Objective：To evaluate the analgesia effect and adverse reaction of subarachnoid block combined with remifentanil PCIA（patient controlled intravenous analgesia,PCIA）in labor analgesia.Methods：85 single fetus,term prenancy,primipara were randomly divided into epidural analgesia group（Group A,n=28）,subarachnoid block combined with remifentanil PCIA group（Group B,n=29）and remifentanil PCIA group（Group C,n=28）.The general data of patients,analgetic onset time,VAS score at 10,15,30,60 and 90 minutes after the analgesia began,analgesia effect,Bromage score,were recorded.The duration of labor stage,the fetal distress and neonatal asphyxia rate,the mode of delivery,postpartum emorrhage,the use rate of oxytocin in the delivery progress,and adverse reaction were recorded too.Results：The analgetic onset time in group C was shorter than in group A and group B（P〈0.01）.The VAS score at 10,15,30,60 and 90 minutes after the analgesia began in group A and group B were lower than group C（P〈0.01）.The VAS score at 10,15,30 minutes in group B were lower than in group A（P〈0.01）.The VAS score at 60 and 90 minutes were no significant different between group A and group B（P〈0.05）.The analgesisa effect in group A and group B were better than in group C（P〈0.05）.The duration of stageⅠand stageⅡin group A were significant longer than those in group B and group C（P〈0.05）.the rate of oxytocin use in the delivery progress in group A was higher than in group B and group C（P〈0.05）.There were no significant difference in Bromage score,the fetal distress and neonatal asphyxia rate,the mode of delivery,postpartum emorrhage among the three groups（P〈0.05）.The rate of dizzy,nausea and vomiting were significant higher in group C than in group A and group B（P〈0.05）.Conclusion：The anesthesic mode of subarachnoid block combined with remifentanil PCIA is effective for labor analgesia,and has no influence on the delivery outcome,without increasing adverse reations.