瑞芬太尼联合会阴阻滞用于分娩镇痛的临床探讨-东南大学学报医学版

瑞芬太尼联合会阴阻滞用于分娩镇痛的临床探讨

单位：马鞍山市妇幼保健院麻醉科, 安徽马鞍山 243001

分类号：R971.2;R714.3

出版年·卷·期（页码）：2017·36·第四期（599-602）

摘要：

目的：观察两种分娩镇痛方法对产妇第二产程镇痛效果、会阴损伤情况，比较产妇、麻醉医生、产科医生、助产士接受率。方法：选择在本院住院161例分娩产妇，随机分为硬膜外分娩镇痛组（Y组，76例）及瑞芬太尼静脉分娩镇痛+会阴阻滞组（J组，85例）。采用视觉模拟评分（VAS）评估镇痛效果，比较两组产程时间、会阴损伤情况、第二产程VAS、产妇和医护接受率。结果：（1）Ⅰ、Ⅱ度会阴裂伤率J组高于Y组，差异有统计学意义（P<0.01）；Ⅲ度会阴裂伤率、阴道裂伤两组差异无统计学意义（P>0.05）。第二产程VAS分值Y组低于J组，但差异无统计学意义。（2）产妇接受率Y组低于J组（P<0.05），麻醉医生、产科医生和助产士接受率Y组高于J组（均P<0.05）。结论：硬膜外分娩镇痛较静脉分娩镇痛联合会阴阻滞能够显著减少会阴损伤，但第二产程镇痛效果两者无差异；静脉分娩镇痛产妇接受率高，而硬膜外分娩镇痛麻醉医生、产科医生和助产接受率高。

Objective:To observe the analgesic effect of two kinds of labor analgesia methods on the second stage of labor, perineal injury and its acceptance among maternity patients, anesthesiologists, obstetricians, midwives. Methods:One hundred and sixty-nine women were randomly divided into 2 groups:epidural analgesia group (group Y,76 cases), remifentanil intravenous labor analgesia + perineum block group (group J,85 cases). The duration of labor, perineal injury, the second labor analgesia (VAS), maternal and anesthesiologist acceptance rates were compared. Results:(1) The rate of Ⅰ,Ⅱ degree perineal laceration was higher in group J than that in group Y (P<0.01). Ⅲ degree perineal laceration rate, vaginal laceration had no significant difference between the two group(P>0.05); second stage VAS score in group Y was lower than that in group J without significant difference. (2) The rate of maternal acceptance in group Y was lower than that in group J (P<0.01). The acceptance rate of anesthesiologists, obstetricians and midwifery were significantly higher in group Y than those in group J (P<0.01). Conclusion:Epidural analgesia compared with intravenous labor analgesia perineal block can significantly reduce the perineal injury, there is no significant difference of the second stage labor analgesia; intravenous labor analgesia is well accepted by maternity patients, while epidural analgesia anesthesia labor is well accepted among obstetricians and midwives.

参考文献：

[1] 徐萌艳,徐鑫芬,王芳,等.硬膜外麻醉分娩镇痛降低初产妇会阴侧切率的研究[J].护理与康复,2013,12(9):822-824.
[2] ELEY V A,CALLAWAY L,van ZUNDERT A A.Developments in labour analgesia and their use in Australia[J].Anaesth Intensive Care,2015,43(Suppl):12-21.
[3] SNG B L,KWOK S C,SIA A T.Modern neuraxial labour analgesia[J].Curr Opin Anaesthesiol,2015,28(3):285-289.
[4] SOLEK-PASTUSZKA J,ZAGRODNIK-ULAN E,BOHATYREXICZ R,et al.Remifentanil for labour pain relief[J].Anaesthesiol Intensive Ther,2015,47(1):82-86.
[5] STOCKI D,MATOT I,EINAV S,et al.A randomized controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women[J].Anesth Analg,2014,118(3):589-597.
[6] STOURAC P,KOSINOVA M,HARAZIM H.The analgesic efficacy of remifentanil for labour.Systematic review of the recent literature[J].Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub,2016,160(1); 30-38.
[7] GYHAGEN M,BULLARBO M,NIELSEN T F,et al.Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth:a national cohort study in singleton primiparae after vaginal or caesarean delivery[J].BJOG,2013,120(2):152-160.
[8] 罗小玲,陈世彪,欧阳伟子,等.瑞芬太尼用于静脉自控分娩镇痛对产妇胎儿及新生儿的影响[J].现代医学,2014,42(9):1043-1046.
[9] 黄鑫,高启俊,王月玲,等.瑞芬太尼静脉自控镇痛麻醉用于产妇分娩镇痛效果探讨[J].中外医学研究,2014,12(30):3-5.
[10] 李兵,王燕琼,苏纲.瑞芬太尼静脉自控镇痛与罗哌卡因复合舒芬太尼硬膜外自控镇痛用于分娩镇痛的比较[J].临床麻醉学杂志,2012,8(28):781-783.
[11] van de VELDE M.Patient-controlled intravenous analgesia remifentanil for labor analgesia:time to stop,think and reconsider[J].Curt Opin Anaesthesiol,2015,28(3):237-239.
[12] 沈富毅,徐振东,刘志强.瑞芬太尼用于静脉分娩镇痛的研究进展[J].国际麻醉学与复苏杂志,2014,11(35):l034-1036.
[13] MUCHATUTA N A,KINSELLA S M.Remifentanil for labour analgesia:time to draw breath?[J].Anaes thesia,2013,68(3):231-235.
[14] BONNER J C,MCCLYMONT W.Respiratory arrest in an obstetric patient using remifentani patient-controlled analgesia[J].Anaesthesia,2012,67(5):538-540.
[15] MARR R,HYAMS J,BYTHELL V.Cardiac arrest in an obstettic patient using remifentanil patient-contr olled analgesia[J].Anaesthesia,2Ol3,68(3):283-287.
[16] STOCKI D,MATOT I,EINAV S,et a1.A randomize controlled trial of the efficacy and respiratory effects of patient-controlled intravenous remifentanil analgesia and patient-controlled epidural analgesia in laboring women[J].Anesth Analg,2014,118(3):589-597.
[17] FREEMAN L M,BLOEMENKAMP K W,FRANSSEN M T,et a1.Patient controlled analgesia with remifentanil versus epidural analgesia in labour:randomised multicentre equivalence trial[J].BMJ,2015,350:h846.
[18] 汪慧平,杜云霞,黄晓霞.剖宫产后停止硬膜外自控镇痛后切口疼痛的预防[J].现代医学,2012,40(6):639-642.
[19] 范晓英,苏玉强.氯普鲁卡因与罗哌卡因用于硬膜外自控分娩镇痛的疗效比较[J].中国基层医药,2014,21(13):1981-1983.
[20] 黄绍强.分娩镇痛目前的观点和研究进展[J].上海医学,2016,39(4):248-252.

服务与反馈：

【文章下载】【发表评论】【查看评论】【加入收藏】

提示：您还未登录，请登录！点此登录