靶控输注瑞芬太尼用于分娩镇痛的初步临床研究  

Target-controlled infusion with remifentanil for labour analgesia

作　　者：曲元[1] 周岩[1] 白勇[1] 王东信[1] 

机构地区：[1]北京大学第一医院麻醉科,北京100034

出　　处：《中国医刊》2009年第7期28-30,共3页Chinese Journal of Medicine

摘　　要：目的探讨瑞芬太尼靶控输注用于分娩镇痛的安全性及有效性。方法选择60例阴道分娩单胎足月初产妇随机分为两组:硬膜外组(EA组)给予0.1%罗哌卡因和0.5μg/ml舒芬太尼的混合液10ml,然后连接0.08%罗哌卡因和0.4μg/ml舒芬太尼的硬膜外病人自控镇痛泵;瑞芬太尼组(RA组)静脉给予瑞芬太尼血浆靶浓度2μg/L输注1小时后按上述硬膜外给药。监测并记录镇痛后10、20、40、60分钟产妇的平均动脉压(MAP)、心率(HR)、呼吸次数(RR)、血氧饱和度(spO_2)。并记录VAS镇痛评分、VRS镇静评分、胎心率(FHR)及不良反应等。结果 RA组镇痛后10、20、40、60分钟与EA组相比,VAS评分差异无显著性(P>0.05)。镇痛后1小时内,RA组的MBP、HR及RR显著低于EA组(P<0.05)。RA组的SpO_2显著下降,非常显著低于EA组(92.8%±2.2:98.4%±0.8;P<0.001)。RA组的呼吸频率显著减慢,为14.8±1.9次/分,显著低于EA组(P<0.01)且比EA组有较高的镇静作用(VRS评分)(1.2±0.4:1.0±0.0;P<0.05),但上述参数均在可允许的生理范围内。镇痛后两组间的胎心次数在产程中的各个时间点差异无显著性。Apgar评分出生后1分钟≥19分,出生后5分钟均为10分,两组间差异无显著性。结论瑞芬太尼靶控输注2μg/L用于分娩镇痛,可达到与硬膜外镇痛同样的镇痛效果,而对母婴产生较少不良反应。为减少母婴缺氧的可能性,连续血氧饱和度的监测是必须的。Objective The aim of this study was to investigate the safety and efficacy of labor analgesia with a targetcontrolled infusion （TCI） of the short acting u-receptor agonist remifentanil compared with that of a combination of ropivacaine and sulfentanil administered epidurally. Methods Sixty uniparous parturients were randomly allocated to two groups （n = 30/group）. Parturients in the epidural group （EA） received a bolus dose of 10 ml of 0.1% ropivicaine and 0.5 ug/ml of sufentanil followed by patient-controlled epidural analgesia （PCEA） of 0.08% ropivacaine and 0.4ug/ml snfentanil. Parturients in the remifentanil group （RA） were administered with TCI remifentanil with a plasma concentration of 2 ug/L for an hour and then analgesia was switched to the PCEA as described above. Non-invasive arterial blood pressure, heart rate, respiratory rate, and pulse oximetry （SpO2 ） were monitored. The visual analogue scale （VAS） of pain and sedation, the fetal heart rate （FHR） and the side effects of analgesia were observed. Results There were no significant differences between the two groups in the VAS scores at 10, 20, 40 and 60 min after initiation of analgesia （P 〉 0.05 ）. The mean blood pressure, heart rate and respiratory rate were significant lower in the RA group than in the EA group at one hour of analgesia （ P 〈 0.05 ）. SpO2 in the RA group was siguificantly lower than that before analgesia, and was also significantly lower when compared with the EA group （92.8% ± 2.2： 98.4% ± 0.8 ; P 〈 0. 001 ）. Remifentanil also produced more profounded sedation （ 1.2 ± 0.4：1.0 ± 0.0; P 〈 0.05） as compared with epidural analgesia. However, all these parameters were within a normal physiological range. Conclusion TCI Remifentanil at 2 ug/L can provide the same degree of analgesia afforded by epidural analgesia with the combination of ropivacaine and sulfentanil without any clinical significance of side effects in both mothers and neonates. Our results suggest that the us

关 键 词：阿片类药物 瑞芬太尼 靶控输注 分娩镇痛 

分 类 号：R614[医药卫生—麻醉学] R971[医药卫生—外科学]