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目的探讨椎管内联合静脉麻醉不同产程行分娩镇痛的有效性和安全性。方法 450例初产妇随机分为腰麻-硬膜外联合阻滞(CSEA)组、瑞芬太尼(RF)组和对照组,每组150例。CSEA组产妇仅在第一、三产程实施椎管内镇痛;RF组在第一产程实施椎管内镇痛,第二、三产程实施瑞芬太尼自控静脉镇痛;对照组未实施任何镇痛。观察三组在第二产程视觉模拟评分(VAS)、生命体征改变、动脉血气分析、胎心率、第二产程时间、新生儿Apgar评分、不良反应等。结果 RF组第二产程VAS评分明显优于其他两组,RF组动脉血二氧化碳分压(Pa CO2)高于CSEA组和对照组(P<0.05),其他指标三组比较差异无统计学意义(P>0.05)。结论不同产程使用椎管内联合瑞芬太尼自控镇痛行全产程分娩镇痛,尤其是瑞芬太尼静脉自控镇痛应用于第二、三产程,镇痛效果满意,对产妇和胎儿无不良影响,椎管内联合瑞芬太尼自控镇痛,取长补短,是一种安全有效的全产程镇痛方法 ,值得在临床进一步探讨研究。
Objective To investigate the effectiveness and safety of spinal analgesia during spinal anesthesia in different labor cycles. Methods 450 cases of primipara were randomly divided into spinal anesthesia - epidural block (CSEA) group, remifentanil (RF) group and control group, 150 cases in each group. In the CSEA group, intraspinal analgesia was performed only in the first and third stage of labor. RF group received intraspinal analgesia in the first stage of labor and remifentanil-controlled intravenous analgesia in the second and third stage of labor. In the control group, Analgesia. Visual analogue scale (VAS), vital signs, arterial blood gas analysis, fetal heart rate, time of second stage of labor, neonatal Apgar score, adverse reaction and so on were observed in the three groups. Results The VAS score of the second stage of labor in RF group was significantly better than that of the other two groups. The PaCO 2 of arterial blood in RF group was higher than that of CSEA group and control group (P <0.05), but there was no significant difference among the other three groups P> 0.05). Conclusions The labor-controlled analgesia of spinal canal combined with remifentanil in different stages of labor is performed during the whole delivery period. In particular, intravenous controlled-release analgesia of remifentanil is applied to the second and third stage of labor. The analgesic effect is satisfactory. Adverse effects, intraspinal combined with remifentanil self-controlled analgesia, learn from each other, is a safe and effective full-term analgesic method, it is worth further study in clinical research.