瑞芬太尼术前镇痛在急症剖宫产中的应用

目的观察瑞芬太尼术前镇痛用于急症剖宫产对产妇及新生儿的影响。方法将足月妊娠急症剖宫产且伴有术前剧烈宫缩痛产妇60例随机分为A组和B组，每组30例。A组给予瑞芬太尼0．3μg／kg静脉注射＋0．04μg·kg-1·min-1持续静脉泵注，镇痛不足时追加0．15μg／kg，再按常规行腰硬联合麻醉；B组按常规行腰硬联合麻醉。监测记录产妇疼痛情况、呼吸及循环变化、麻醉操作时患者配合情况、麻醉操作耗时、不良反应、新生儿Apgar评分及脐动脉血气分析。术后比较2组以上指标。结果A组疼痛明显缓解、麻醉操作时患者配合情况好于B组，麻醉操作耗时（4．5±1．2）min少于B组的（6．2±1．6）min，差异有统计学意义（P〈0．01）；2组血压、心率、SpO2、新生儿Apgar评分及脐动脉血气分析比较，差异无统计学意义（P〉0．05）。结论瑞芬太尼术前镇痛用于急症剖宫产效果良好、有利于麻醉操作，对产妇及新生儿无明显不良反应。

Application of remifentail using as preoperative analgesia in ergency cesarean section

Objective To observe the affection of using remifentail as preoperative analgesia in emergency cesarean section for maternal and neonatal. Methods 60 cases intended to be under emergency cesarean section which are full-term pregnant and suffering acute labor pain,were divided into group A and group B ,each of 30 cases. Group A were gave intrave- nous injection remifentanil 0.31μg/kg,then 0.04μg ·kg-1· min-1 intravenous infusion. Add 0. 15μg/kg if analgesia was in- sufficient, and then used combined spinal-epidural anesthesia routinely;Group B were accorded to conventional combined spi- nal-epidural anesthesia. Monitor the maternal pain, breathing and circulation changes, the situation of patient＇s cooperation with anesthesia operation, and time-consuming of anesthesia operation, adverse reactions, neonatal Apgar scores and umbilical arteri- al blood gas analysis. Results Pain of group A significant relieied, patients with narcotic operations of group A were better than group B, anesthesia and operating time of group A （4.5 ± 1.2 ） min] less than that of group B （ 6.2 ± 1.6 ） min ], the difference was statistically significant（P 〈 0.01 ） ; Compared with blood pressure, heart rate, SpO2, neonatal Apgar scores and umbilical arterial blood gas analysis, the difference were not statistically significant（P 〉 0.05）. Conclusion Preoperative an- algesia with remifentanil had good effects for the emergency cesarean section, and was conducive to anesthesia operation, but had no significant adverse effects to maternal and newborn.