不同浓度瑞芬太尼用于分娩镇痛的临床观察

目的：观察不同浓度的瑞芬太尼用于分娩镇痛的临床疗效，以确定最佳剂量。方法选择自然分娩的足月初产妇180例，随机分为A、B、C三组，每组60例，瑞芬太尼静脉输注的浓度分别为0.02μg/（kg·min）、0.04μg/（kg·min）和0.06μg/（kg·min），比较各组的产程时间、宫缩疼痛视觉模拟评分（VAS）、产妇生命体征、应用催产素及器械情况、剖宫产率及新生儿Apgar评分和胎儿胎心率。结果产妇在第一、第二、第三产程持续时间、剖宫产率、催产素使用及器械使用比较差异无统计学意义；A、B两组Ramsay评分相比差异无统计学意义，但C组最高（P＜0.05）；C组出现20例低氧血症，1例出现过度镇静，表现为SpO2迅速下降、嗜睡，但停药并辅助呼吸90 s后恢复；与A、B两组相比，C组新生儿Apgar评分在出生后1 min较低（P＜0.05），但经吸氧5 min后评分均达到10分；A、B两组药物对胎儿胎心率无显著影响，C组有一定影响。结论瑞芬太尼实施分娩镇痛，此药背景输注速度以0.04μg/（kg·min）时镇痛完善，并发症少。

Clinical observation of different concentrations of fentanyl for labor analgesia’s treatment

Objective To determine the optimal dose of fentanyl by using different concentrations of fentanyl for labor analgesia and studying their clinical curative effects. Methods 180 cases of full-term nulliparous women were randomly selected and divided into A, B and C three groups（60 cases in each group）;fentanyl’s concentrations were set as 0.02μg/（kg·min）, 0.04μg/（kg·min）, and 0.06μg/（kg·min）for intravenous infusion;and we have compared the three groups’labor time, contractions pain visual analogue scale（VAS）, maternal vital signs, heart rates, applications of oxytocin and equipment using situations, while cesarean section rate, neonatal Apgar score and fetal heart rates were also used as observation indexes for research. Results In the first, second, third labor duration, women’s cesarean section rates, oxytocin use and equipment use, heart rates had no statistically significant differences;A and B the two groups of Ramsay score had no significant difference, but the group C’s score was higher（P〈0.05）;Group C had 20 cases of hypoxemia and 1 case of excessive sedation which was characterized by rapid drop in SpO2 and lethargy, but with drug withdrawal and auxiliary breath after the 90 s the patients was restored;Compared with the A and B to groups, group C’s 1 min after neonatal Apgar score at birth was lower（P〈0.05）, but the oxygen 5 min after scoring was 10 points;A and B two groups had no significant effects on fetal heart rate, while Group C had a certain effect. Conclusion Using fentanyl at the concentration of 0.04μg/（kg·min）for the treatment of labor analgesia has better analgesic effects and fewer complications.