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不同给药模式在瑞芬太尼静脉分娩镇痛中的应用
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DOI:
作者:
董斌、姜山、冯春、刘欣
Dong Bin ,JIANG Shan,Feng Chun,Liu Xin
作者单位:
武汉市妇女儿童医疗保健中心
Department of Anesthesiology,Wuhan Medical Health Center for women and children,430016,Wuhan,Hubei,China.
关键词:
瑞芬太尼;分娩镇痛;静脉;持续输注;间断单次输注
Remifentanil;labor analgesia;intravenous;continuous infusion;discontinuous single transfusion
摘要:
[摘要] 目的 观察不同给药模式在瑞芬太尼静脉分娩镇痛中的应用,为临床提供安全有效的镇痛方式。方法 对武汉市妇女儿童医疗保健中心2014年6月—2015年4月收治,拟行阴道分娩的产妇450例:其中 A组150例(无分娩镇痛组),选择分娩镇痛的300例产妇按照抽签法随机分为B组(瑞芬太尼静脉持续输注分娩镇痛组)和C组(瑞芬太尼静脉间断单次输注分娩镇痛组),各150例。其中B组以瑞芬太尼0.1μg/kg/min静脉持续输注;C组以瑞芬太尼静脉间断单次给药:单次剂量20μg(5μg/ml)、间隔时间5min。记录并比较三组产妇整个分娩过程中不同时间点的视觉模拟评分(Visual analog scale,VAS)、Ramsay镇静评分,同时记录三组产妇的第一产程活跃期、第二、第三产程时间、胎心率变化、最终分娩方式、催产素使用率、器械助产率、不良反应发生率以及分娩过程中血流动力学变化,此外记录并比较三组新生儿娩出时Apgar评分、脐动脉血气分析和B、C组的瑞芬太尼总用药量以及脐动脉/脐静脉血药浓度比。结果 B、C组产妇的第一产程活跃期明显短于A组(P<0.05),但三组产妇的第二、第三产程时间以及产程中胎心率变化无明显差异(P>0.05);B、C组产妇实施分娩镇痛后疼痛程度明显下降,同时B组产妇活跃期每间隔15min、宫口开全时、胎儿娩出时的VAS评分最低、C组其次、A组最高,组间比较有明显差异(P<0.05);而B、C组的Ramsay镇静评分均明显优于A组(P<0.05);B组最终的剖宫产率、催产素使用率和器械助产率明显低于A组(P<0.05),略低于C组(P>0.05);三组产妇血流动力学变化以及恶心/呕吐、呼吸抑制、宫缩乏力等不良反应的发生率无明显差异(P>0.05);同时三组新生儿娩出时均未发生新生儿窒息,同时Apgar评分以及脐动脉血气分析无明显差异;而B、C两组的瑞芬太尼总用药量以及脐动脉/脐静脉血药浓度比也无明显差异(P>0.05)。结论 瑞芬太尼静脉输注用于分娩镇痛时镇痛效果明显,对母婴影响小,但静脉持续输注模式优于静脉间断单次输注,是一种安全有效的分娩镇痛方式。
[ Abstract ] Objective To observe the application of different medication models in the intravenous labor analgesia of remifentanil,to provide safety and effective analgesic method for clinic.Methods A total of 450 maternals,who needed vaginal delivery in Wuhan medical health center for women and children during April 2014 to June 2015,were enrolled in the study.The maternals were randomly divided into 3 groups: group A(no labor analgesia)、group B(labor analgesia with remifentanil continuous infusion) and C group (labor analgesia with remifentanil discontinuous single transfusion),each of three groups were 150 cases. Group B with remifentanil 0.1μg/kg/min intravenous continuous infusion;group C with remifentanil intravenous discontinuous single transfusion: a single dose of 20μg(5μg/ml)、interval time 5 min. Recorded and compared with visual analog scale (VAS) and Ramsay sedation score at different points in time of three groups during the whole labor process,simultaneous recorded the first stage of labor activity、the second、third labor duration、fetal heart rate、final delivery method、usage of oxytocin、the rate of apparatus deliver、adverse reaction rate and the changes of hemodynamic during delivery in three groups,besides recorded and compared with neonatal Apgar score、umbilical arterial blood gas analysis in three groups,also recorded the total dosage of remifentanil and the blood concentration ratio of umbilical artery/umbilical vein.Results The first stage of labor activity was significantly in the group B and C were shorter than group A(P<0.05), but there was no significant difference of the second、third labor duration and the fetal heart rate during the labor process among the three groups (P>0.05);the pain of maternal delivery in group B and C decreased obviously after labor analgesia, At the same time the VAS scores per 15min in activity phase,、at cervix opening whole、fetal disengagement in group B were lowest, followed by group C, group A was the highest,there were significant differences between three groups (P<0.05);the Ramsay sedation score in group B and C was significantly better than group A (P<0.05);the rates of cesarean section、usage of oxytocin and the rate of apparatus deliver in group B were significantly lower than group A (P<0.05), and were slightly lower than group C(P>0.05);there was no significant difference among three groups with the changes of hemodynamic during delivery and the incidence rate of nausea/vomiting、respiratory depression、uterine inertia(P>0.05);there was no asphyxia neonatorum in three groups,the Apgar scores and umbilical arterial blood gas analysis was no significant difference in three groups;also there was no significant difference between group B、C with the total dosage of remifentanil and the blood concentration ratio of umbilical artery/umbilical vein(P>0.05).Conclusion The analgesic effect of remifentanil intravenous infusion for labor analgesia is obviously,but continuous infusion of remifentanil is better than discontinuous single transfusion,also little impact on the mother and fetal,it is a safety and effective analgesic method for labor analgesia.
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