摘要
目的:观察瑞芬太尼PCIA联合阴部神经阻滞在分娩镇痛中的效果及对孕妇、胎儿、新生儿的影响。方法:单胎、头位、孕38～40周自然分娩初产妇60例,进入第l产程活跃期后随机分为A、B两组,A组按产科常规处理,应用导乐法; B组第一产程瑞芬太尼以0. 05μg·kg-1·min-1为背景剂量,第二产程瑞芬太尼以0. 075μg·kg-1·min-1为背景剂量,第三产程瑞芬太尼以0. 05μg·kg-1·min-1,均以0. 3μg·kg-1为单次追加剂量,锁定时间为5 min,在胎儿娩出前30 min行双侧阴部神经阻滞,在预计胎儿娩出前10 min将背景剂量改为0. 05μg·kg-1·min-1,直至胎儿娩出。记录疼痛的视觉模拟评分(VAS)、Ramsay镇静评分、呼吸循环指标,监测产妇宫缩及胎心情况,记录新生儿1 min及5 min Apgar评分,采取1 min脐动脉血气,记录器械助产情况等指标。结果:镇痛后A组疼痛VAS显著高于B组,差异有统计学意义(P <0. 05);镇痛后B组Ramsay镇静评分显著高于A组,差异有统计学意义(P <0. 05)。两组产程、器械助产率比较,差异均无统计学意义(P> 0. 05)。A、B两组均无胎儿宫内窘迫及新生儿明显呼吸抑制发生,无产妇循环明显抑制、镇静过度或低氧血症(脉搏血氧饱和度小于90%)发生。结论:瑞芬太尼PCIA联合阴部神经阻滞用于分娩镇痛安全有效。
Objective:To observe the effect of remifentanil PCIA combined with pudendal nerve block in labor analgesia and its influence on pregnant women,fetuses and newborns.Methods:Sixty primipara with single birth,head position and 38-40 weeks of gestation were randomly divided into two groups after entering the active stage of the 1st stage of labor.Group A was treated with Doula according to the routine obstetric treatment.Group B was given remifentanil at the background dose of 0.05μg·kg^-1·min^-1 in the first stage of labor,0.075μg·kg^-1·min^-1 in the second stage of labor and 0.05μg·kg^-1·min^-1 in the third stage of labor,with 0.3μg·kg^-1 as a single additional dose,the locking time was 5 minutes.Bilateral pudendal nerve block was performed 30 minutes before delivery.The background dose was changed to 0.05μg·kg^-1·min^-1 10 minutes before expected delivery until delivery.Visual analogue scale(VAS),Ramsay sedation score and respiratory and circulatory index were recorded.Maternal uterine contraction and fetal heart rate were monitored.Apgar score of 1 min and 5 min of neonates was recorded.Umbilical artery blood gas was taken for 1 min,and device midwifery was recorded.Results:The pain VAS in group A was significantly higher than that in group B(P<0.05),and Ramsay sedation score in group B was significantly higher than that in group A(P<0.05).There was no significant difference between the two groups in labor process and rate of assisted delivery(P >0.05).No fetal distress or neonatal respiratory depression occurred in both groups A and B.No maternal circulation depression,excessive sedation or hypoxemia(pulse oxygen saturation less than 90%)occurred.Conclusion:Remifentanil PCIA combined with pudendal nerve block is safe and effective for labor analgesia.
作者
李以平
欧阳爱平
李优春
黄桂明
钟宝林
LI Yi-ping;OUYANG Ai-ping;LI You-chun;HUANG Gui-ming;ZHONG Bao-lin(Anesthesiology Department of Ganzhou People's Hospital,Ganzhou,Jiangxi 341000)
出处
《赣南医学院学报》
2018年第12期1201-1205,共5页
JOURNAL OF GANNAN MEDICAL UNIVERSITY
基金
赣州市指导性科技计划项目(编号:GZ2013ZSF230)
关键词
瑞芬太尼
分娩镇痛
静脉自控镇痛
阴部神经阻滞
Remifentanil
Labor analgesia
Intravenous controlled analgesia
Pudendal nerve block
