CAJ | 학술논문

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。
목적：통과여요경연합마취(CSEA)후자공진통법비교,탐토서분태니자공정맥진통법(PCIA)응용우분면진통적유효성화안전성。방법초산부105례,수궤분위A조、B조여대조조,각35례。대조조미행분면진통；A조급여주망막하강주사서분태니5μg,연후련접경막외진통빙；B조급여정맥주사25μg부하량적서분태니,연후련접정맥전자진통빙。관찰삼조산부시각모의평분(VAS)、산정시간、분면방식、신생인Apgar평분급제동맥혈기、불량반응。결과진통후, A、B조VAS평분하강,여대조조비교차이유통계학의의(P<0.01), A、B조간차이무통계학의의(P>0.05)。A、B량조신생인Apgar평분、제동맥혈기비교차이무통계학의의(P>0.05)。A조제이산정시간연장,조간차이유통계학의의(P<0.05), B조재과도진정화호흡억제상명현다우A조,조간차이유통계학의의(P<0.05)。결론서분태니PCIA진통효과비CSEA-자공경막외진통(PCEA)초차,단잉능제공유효진통효과,조작간단무창,대산정화태인무불량영향,작위산부거절혹금기요경연합마취적체대수단,치득진일보탐토추엄。
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.