瑞芬太尼自控镇痛与硬膜外腔自控镇痛应用于分娩镇痛的疗效比较  

Curative effect comparison of Remifentanil patient-controlled intravenous analgesia and patient-controlled epidural analgesia for labor analgesia

作　　者：余祯祎 任秋生 

机构地区：[1]浙江省宁波市鄞州人民医院麻醉科,浙江宁波315000

出　　处：《中国医药导报》2014年第34期70-73,共4页China Medical Herald

基　　金：浙江省中医药科技计划项目(编号2011ZB133)

摘　　要：目的比较瑞芬太尼自控镇痛（PCIA）与罗哌卡因复合舒芬太尼硬膜外腔自控镇痛（PCEA）的疗效。方法选择2013年1月-2014年1月宁波市鄞州人民医院足月妊娠的健康初产妇120例,随机分为PCIA组与PCEA组,每组产妇60例。PCIA组产妇在分娩时先静脉注射瑞芬太尼25μg后连接自控镇痛泵,PCEA组产妇在分娩时先在硬膜外腔注射10 m L的0.1%罗哌卡因＋0.5μg/m L舒芬太尼混合液后连接硬膜外自控镇痛泵,观察并比较两组产妇镇痛前（T0）、镇痛后10 min（T1）、镇痛后60 min（T2）及宫口开全时（T3）视觉模拟评分（VAS）,并记录两组孕妇产程时间、分娩方式、新生儿Apgar评分及不良反应情况。结果两组产妇T0时VAS评分无明显差异（P〉0.05）,T1、T2、T3VAS评分[（4.32±0.68）、（3.27±0.54）、（3.14±0.83）、（4.44±1.01）、（3.41±0.64）、（3.17±0.78）分]均较同组T0时[（8.31±1.07）、（8.29±1.48）分]明显改善（P〈0.01）,且两组改善幅度相近（P〉0.05）。PCIA组第一产程、第二产程[（475.31±117.25）、（42.12±5.68）min]明显短于PCEA组[（529.68±133.45）、（58.73±5.14）min]（P〈0.05或P〈0.01）,两组产妇分娩方式、新生儿Apgar评分比较差异无统计学意义（P〉0.05）,PCIA组不良反应发生率（13.33%）明显低于PCEA组（28.33%）（χ^2=4.09,P〈0.05）。结论瑞芬太尼PCIA用于分娩镇痛能取得与罗哌卡因复合舒芬太尼PCEA相近的镇痛效果,瑞芬太尼PCIA具有起效快、操作简便、不良反应发生率低及对产程影响较少等优点。Objective To compare curative effect of Remifentanil patient-controlled intravenous analgesia（PCIA） and patient-controlled epidural analgesia（PCEA） of Ropivacaine combined with Sulfentanyl. Methods 120 cases of healthy primiparae with uterogestation given medical treatment in Yinzhou People＇s Hospital of Ningbo City from January 2013 to January 2014 were selected and divided into PCIA group and PCEA group at random, with 60 cases of primiparae in either group. The primiparae in PCIA group were given 25 μg Remifentanil by intravenous injection before joint of self-control PCA when giving birth, while the primiparae in PCEA group were given epidural injection of 10 m L 0.1%Ropivacaine and 0.5 μg/m L Sulfentanyl mixed fluid before joint of self-control PCA when giving birth. The VAS of primiparae in two groups before analgesia（T0）, 10 minutes after analgesia（T1）, 60 minutes after analgesia（T2） and upon full cervical dilation（T3） were observed and compared, and the labor courses, labor modes, Apgar scores and untoward effect occurrences of primiparae in two groups were recorded as well. Results VAS of primiparae in two groups showed no obvious differences at T0（P〉0.05）, but were obviously improved at T1, T2 and T3[（4.32±0.68）,（3.27±0.54）,（3.14±0.83）,（4.44 ±1.01）,（3.41 ±0.64）,（3.17 ±0.78） min] when compared with that at T0[（8.31 ±1.07）,（8.29 ±1.48） min]（P〈0.01）, and the improvement rate of primiparae in two groups was close to each other（P〉0.05）. The first and second stages of labor of primiparae in PCIA group [（475.31 ±117.25）,（42.12±5.68） min] were shorter than those in PCEA group [（529.68±133.45）,（58.73±5.14） min]（P〈0.05 or P〈0.01）. After comparing the labor modes and Apgar scores of primiparae in two groups, no statistical differences appeared（P〉0.05）. The occurrence rate of untoward effect of primiparae in PCIA group（13.33%） were lower than those in PCEA group（28.33%）. Conclusion The ana

关 键 词：分娩镇痛 瑞芬太尼 罗哌卡因 舒芬太尼 硬膜外腔 自控镇痛 

分 类 号：R614.2[医药卫生—麻醉学]