CAJ | 학술논문

目的对比瑞芬太尼静脉分娩镇痛与罗哌卡因硬膜外分娩镇痛对母婴的影响,探讨瑞芬太尼静脉分娩镇痛的可行性.方法选择足月单胎妊娠初产妇309例.采用随机数表法分为A、B、C组,各103例.镇痛目标视觉模拟评分(VAS)≤3分.A组以0.06μg/(kg·min)的剂量静脉持续滴注瑞芬太尼,0.01 μg/(kg·min)的剂量增减；B组设定瑞芬太尼单次静脉注射剂量为0.6 μg/kg,锁定间隔2min,宫缩前给药,以0.05μg/kg的剂量增减；C组用0.1％罗哌卡因(其中含芬太尼2 mg/L)5 ml/h实施硬膜外分娩镇痛.记录产妇平均动脉压(MAP)、HR、脉搏血氧饱和度(SpO2),各产程时间、宫缩痛VAS评分、Ramsay镇静评分,止痛剂用量、催产素用量、分娩方式、出血量等.记录新生儿Apgar评分,胎盘端脐动脉血气分析值.结果 ①3组产妇分娩镇痛后MAP、HR、SpO2、子宫颈口3 cm至胎儿娩出时间及出血量的差异均无统计学意义(P＞0.05).A、B、C组Ramsay镇静评分分别(3.3±0.5)、(2.0±0.6)和(2.0±0.0)分,A组与B、C组比较的差异均有统计学意义(P＜0.05).②分娩镇痛后3组胎心率、新生儿Apgar评分(1、5 min)、胎盘脐动脉pH值、氧分压及二氧化碳分压的差异无统计学意义(P＞0.05).③A组和B组瑞芬太尼用量分别为(0.065±0.006)和(0.084±0.004) μg/(kg·min),组间差异有统计学意义(P＜0.05).④A、B、C组恶心呕吐发生率分别为8.7％ (9/103)、11.6％(12/103)和5.8％ (6/103),B组与C组间差异有统计学意义(P＜0.01),B组与A组间差异有统计学意义(P＜0.05),A组与C组间差异无统计学意义(P＞0.05).3组缩宫素、器械助产等干预措施使用率及剖宫产率的差异无统计学意义(P＞0.05).结论瑞芬太尼静脉持续输注用于分娩镇痛安全有效,方便简单,可以取代硬膜外自控镇痛术用于产妇的分娩镇痛.
목적 대비서분태니정맥분면진통여라고잡인경막외분면진통대모영적영향,탐토서분태니정맥분면진통적가행성.방법 선택족월단태임신초산부309례.채용수궤수표법분위A、B、C조,각103례.진통목표시각모의평분(VAS)≤3분.A조이0.06μg/(kg·min)적제량정맥지속적주서분태니,0.01 μg/(kg·min)적제량증감；B조설정서분태니단차정맥주사제량위0.6 μg/kg,쇄정간격2min,궁축전급약,이0.05μg/kg적제량증감；C조용0.1％라고잡인(기중함분태니2 mg/L)5 ml/h실시경막외분면진통.기록산부평균동맥압(MAP)、HR、맥박혈양포화도(SpO2),각산정시간、궁축통VAS평분、Ramsay진정평분,지통제용량、최산소용량、분면방식、출혈량등.기록신생인Apgar평분,태반단제동맥혈기분석치.결과 ①3조산부분면진통후MAP、HR、SpO2、자궁경구3 cm지태인면출시간급출혈량적차이균무통계학의의(P＞0.05).A、B、C조Ramsay진정평분분별(3.3±0.5)、(2.0±0.6)화(2.0±0.0)분,A조여B、C조비교적차이균유통계학의의(P＜0.05).②분면진통후3조태심솔、신생인Apgar평분(1、5 min)、태반제동맥pH치、양분압급이양화탄분압적차이무통계학의의(P＞0.05).③A조화B조서분태니용량분별위(0.065±0.006)화(0.084±0.004) μg/(kg·min),조간차이유통계학의의(P＜0.05).④A、B、C조악심구토발생솔분별위8.7％ (9/103)、11.6％(12/103)화5.8％ (6/103),B조여C조간차이유통계학의의(P＜0.01),B조여A조간차이유통계학의의(P＜0.05),A조여C조간차이무통계학의의(P＞0.05).3조축궁소、기계조산등간예조시사용솔급부궁산솔적차이무통계학의의(P＞0.05).결론 서분태니정맥지속수주용우분면진통안전유효,방편간단,가이취대경막외자공진통술용우산부적분면진통.
Objective To assess the safety and feasibility of remifentanil in intravenous labor analgesia for maternal and infant with remifentanil intravenous and ropivacaine epidural labor analgesia.Methods All 309 fullterm pregnant women with single fetal were randomly divided into three groups:group A received 0.06 μg/(kg · min) remifentanil as background continuous intravenous infusion,increasing or decreasing the dose of 0.01 μg/(kg · min) ; group B received 0.6 μg/kg remifentanil as bolus and 2 min lock-out time before uterus constriction coming,increasing or decreasing the dose of 0.05 μg/kg; group C received epidural labor analgesia with 0.1％ ropivacaine (including fentanyl 2 mg/L) 5 ml/h.Mean blood pressure,heart rate,saturation of blood pulse,the pain visual analogue score and ramsay score (RSS) of maternity were recorded.Remifentanil and oxytocin dosage,maternity amount of bleeding,labour process,mode of delivery,neonatal Apgar score and the numerical of umbilical artery blood-gas analysis were also observed.Results Three groups of maternities after labor analgesia had normal vital signs; neonatal Apgar score,the numerical of pH,oxygen partial pressure and CO2 partial pressure of placenta umbilical arterial blood-gas were normal also; RSS in group A [(3.3 ± 0.5) scores] was significantly higher than that in group B [(2.0 ± 0.6) scores] and in group C [(2.0 ± 0.0) scores] (P ＜ 0.05).The maternities in group A were sleepiness; labour process was the longest in group B but there was no significant difference between group B and group A,C ; maternity amount of bleeding,ratio of oxytocin utilization,obstetric forceps,application and cesarean section in each gyoup were also no significantly different.Remifentanil dosage in group A [(0.065 ±0.006)μg/(kg · min)] was less than that in group B [(0.084 ±0.004) μg/(kg · min)] (P＜0.05).The ratio of nausea and vomiting in group B was significantly higher than that in group C (P ＜ 0.01) and higher than that in group A (P ＜ 0.05); there was no significant difference between group A and group C.Conclusion Remifentanil continuous intravenous infusion can be used in the maternity labor analgesia replace PCEA and it is safe,effective,convenient and simple.