瑞芬太尼静脉自控镇痛的分娩镇痛效果及对新生儿的影响  

Analgesic effect and influences on newborn in Remifentanil patient controlled intravenous analgesia for obstetric anesthesia

作　　者：汤平生 

机构地区：[1]广东省东莞市高埗医院麻醉科,广东东莞523000

出　　处：《中国当代医药》2017年第26期117-119,共3页China Modern Medicine

摘　　要：目的探讨应用瑞芬太尼静脉自控镇痛(patient controlled intravenous analgesia,PCIA)的分娩镇痛效果及对新生儿的影响。方法选择2016年1月~2017年3月于我院拟经阴道分娩的初产妇72例,根据就诊顺序随机数法分为对照组(24例)、A组(24例)和B组(24例),对照组采用自然分娩,A和B组分别应用单次剂量为0.2μg/kg和0.5μg/kg的PCIA下分娩,记录产妇的镇痛前(T_0)、镇痛后15 min(T_1)、镇痛后30 min(T_2)和镇痛后60 min(T_3)的呼吸循环指标(心率、平均动脉压和血氧饱和度)和VAS疼痛评分,比较不良反应发生率、缩宫素使用率、剖宫产率和新生儿Apgar评分。结果 B组T_2、T_3时刻,A组T_3时刻的HR、MAP和SpO_2低于T_0时刻,差异有统计学意义(P<0.05);B组T_1、T_2、T_3时刻的HR、MAP和SpO_2低于对照组,差异有统计学意义(P<0.05),AB两组间不存在统计学差异且均在正常范围之内(P>0.05)。T_1~T_3时刻AB两组的VAS评分均显著低于对照组,B组的VAS评分低于A组,差异有统计学意义(P<0.05)。三组产妇的不良反应发生率、缩宫素使用率和剖宫产率均、三组新生儿的1 min和5 min Apgar评分均不存在统计学差异(P>0.05)。结论在分娩时应用单次剂量为0.5μg/kg,背景给药0.05μg/(kg·min)的瑞芬太尼静脉自控镇痛安全有效,值得推广。Objective To observe the analgesic effect and influences on newborn in Remifentanil patient controlled intravenous analgesia（PCIA） for obstetric anesthesia.Methods From January 2016 to March 2017,72 primiparas were randomly divided into the control group,A group and B group.The control group were treated by natural delivery,A and B were treated by PCIA bolus dose 0.2 μg/kg and 0.5 μg/kg respectively.The HR,MAP,SpO2 and visual analogy score（VAS） at 0 min（T0）,15 min（T1）,30 min（T2） and 60 min（T3） were recorded,the adverse reactions,oxytocin used rate,cesarean section rate and newborns′Apgar score were comparatively analyzed.Results The HR,MAP and SpO2 of A group at T3 and B group at T1-T3 were much lower than those at T0（P〈0.05）.The HR,MAP and SpO2 of B group were obviously lower than control group（P〈0.05）,but were within normal range（P〈0.05）.From T1 to T3,the VAS score in A and B group were significantly lower than control group,and VAS in B group were obviously lower than A group（P〈0.05）.There were no significant differences in adverse reactions,oxytocin used rate,cesarean section rate and newborns′Apgar score among three groups（P〉0.05）.Conclusion Remifentanil patient controlled intravenous analgesia with bolus dose 0.5 μg/kg for obstetric anesthesia are safe and effective.

关 键 词：静脉自控镇痛 瑞芬太尼 分娩镇痛 APGAR评分 

分 类 号：R614.24[医药卫生—麻醉学]