瑞芬太尼病人静脉自控镇痛用于分娩镇痛

摘要

目的 评价瑞芬太尼静脉自控镇痛(PCIA)的分娩镇痛效果及安全性.方法 ASA I、单胎初产妇60名,分为瑞芬太尼PCIA组及罗哌卡因硬膜外自控分娩镇痛(PCEA)组,每组30例.产妇官口开张≥3cm时,0.001％瑞芬太尼PCIA组参数设定为:单次剂量1.5ml、锁定时间3min、无背景剂量；0.15％罗哌卡因PCEA组于L3-4间隙行硬膜外穿刺置管后,推注罗哌卡因10ml;20min后硬膜外导管接入PCA仪,PCEA参数设定为:单次剂量2ml、锁定时间15min、背景剂量6ml/h.以视觉模拟评分法(VAS)、警觉-镇静(OAA/S)法、改良Bromage法分别评估两组产妇的镇痛效果、镇静及运动神经阻滞程度,并记录两组产妇第1、第2、第3产程时间、PCA总按压次数与有效按压次数比、新生儿Apgar评分、脐动脉血气、产妇分娩镇痛期间头晕、恶心、呕吐、瘙痒、血压/心率下降、呼吸抑制、尿潴留、发热等不良反应发生情况.结果 两组产妇镇痛实施前后疼痛程度均下降.活跃期每30min及官口开全、胎儿娩出时间点VAS评分PCIA组均高于PCEA组(P＜0.05),表明PCIA组虽有一定的镇痛效果,但不及PCEA组；与PCEA组相比,PCIA组活跃期缩短(P＜0.05)；两组的剖官产、器械助产及顺产数相似；PCIA组产妇头晕、恶心/呕吐、瘙痒及尿潴留的发生率明显高于PCEA组(P＜0.05),而产后发热PCEA组较高.两组产妇分娩镇痛期间均未出现呼吸、循环抑制,新生儿Apgar评分及脐动脉血气亦在正常范围.结论 0.001％瑞芬太尼以单次剂量1.5ml、锁定时间3min的PCIA模式行分娩镇痛,具有一定的镇痛效果；不良反应特别对母婴的呼吸、循环影响轻微.对存在椎管内穿刺禁忌或穿刺操作失败的产妇,瑞芬太尼PCIA可作为一种替代的分娩镇痛模式.%Objective To assess the efficacy of remifentanil PCIA as a labour analgesic, and to investigate the maternal and neonatal side - effects. Methods Sixty parturients with singleton uncomplicated pregnancies received either PCIA with 0. 001 % remifentanil or PCEA with 0. 15% ropivacaine. The group of PCIA received bolus of 1. 5ml remifentanil and lockout time of 3 min,without background infusion. The group of PCEA received bolus of 2ml ropivacaine and lockout time of 15min,with background infusion of 6ml per hour. VAS, OAA/S and Bromage was used to assess pain,sedation and the degree of motor block. Labour course of first,second and third stage,the proportion of of utilitiy push numbers,the umbilical artery Ph,l and 5 min Apgar scores of the neonate were recorded. Side effects during labour and post partum such as dizzy, vomiting, nausea, pruritus, blood pressure and heart rate descent, respiratory depression, urinary retention and fever were also recorded. Results The pain scores were significantly lower after analgesia compared to pre - analgesia between two groups. The mean pain scores in group of PCIA at each time - point were significantly higher than that in group of PCEA( P < 0. 05 ) . This showed that the analgesia efficacy of remifentanil PCIA was lower than ropivacaine PCEA. The course of active phase in group PCIA was short compared to PCEA(P <0. 05) . The incidence of cesarean delivery, forcep delivery and spontaneous vaginal delivery was similar between the two groups. The incidence of dizzy, vomiting, nausea, pruritus and urinary retention in group PCIA was higher than that in group PCEA. There was no circulation or respiratory depression occurance in parturients,and umbilical artery Ph, Apgar scores of the neo-nates were normal between the two groups. Conclusion Remifentanil PCIA is effective in labour analgesia with a bolus of 1. 5ml and lockout time of 3 min, without background infusion.