芬太尼与舒芬太尼在产科分娩镇痛中的比较(1)
[摘要] 目的 观察芬太尼与舒芬太尼分别在产科分娩镇痛中的效果，为产科镇痛治疗的药物选择提供理论支持。 方法 将2011年2月～2013年2月确诊的120例病例纳入研究并随机分成三组，其中C组40例不予镇痛药，B组40例采用芬太尼，A组40例采用舒芬太尼镇痛，A、B两组均行腰麻-硬膜外联合麻醉(CSEA)及病例自控镇痛(PCA)；观察三组VAS疼痛评分、首次加药时间、产程、出血量、催产素、新生儿血气分析及Apgar评分的情况；观察是否出现不良反应。 结果 A组镇痛效果优于B组(P<0.05)，5 min及90 min时的VAS评分均更低(P<0.05)，且对出血量、新生儿血气分析、Apgar评分等指标无显著性影响(P>0.05)，A、B两组催产素使用及产程方面与C组比较差异有统计学意义(P<0.05)；A组不良反应发生率更低(P<0.05)。 结论 芬太尼与舒芬太尼均对产科分娩镇痛具有显著抑制作用，但舒芬太尼起效快，药效持续久，不良反应小，优于芬太尼治疗，值得推广。
[关键词] 芬太尼；舒芬太尼；产科分娩；镇痛
[中图分类号] R714.3 [文献标识码] B [文章编号] 1673-9701(2015)30-0112-03
Comparison of the effect of fentanyl and sufentanil on labor analgesia
HUANG Jianping LUO Xinping SHUAI Jing PENG Sha
Department of Anesthesiology， Ji'an Maternal and Child Health Care Center in Jiangxi Province， Ji'an 343000， China
[Abstract] Objective To observe the effect of fentanyl and sufentanil on labor analgesia， so that theoretical supports to the selection of drugs used for labor analgesia would become available. Methods The 120 diagnosed cases from February 2011 and February 2013 were included in the study and randomly divided into three groups. The 40 patients in group C was not treated with anesthetic analgesia； the 40 patients in group B was administered fentanyl； sufentanil analgesia was applied to the 40 patients in group A. Group A and B received lumbar anesthesia-CSEA and PCA. Observation was made of VAS pain scores， initial administration timing of drug， stages of labor， amount of bleeding， oxytocin， neonatal blood and gas analysis， Apgar scores， and adverse reactions. Results Compared with group B， group A experienced better analgesic effect(P<0.05) and lower VAS pain scores at 5 min and 90 min(P<0.05)， without significant influence on amount of bleeding， neonatal blood and gas analysis， Apgar scores and other indexes(P>0.05). In terms of the application of oxytocin and stages of labor， group A and B significantly differed Group C(P<0.05). group A of adverse reaction occurrence rate was lower(P<0.05). Conclusion Fentanyl and sufentanil are on the obstetric analgesia， has significant inhibitory effect， but sufentanil rapid onset， effect can last for a long time， less adverse reactions， is superior to fentanyl treatment， worthy of promotion.
[Key words] Sufentanil； Fentanyl； Delivery； Analgesia
分娩是大多女性必须经历的过程，子宫条件准备充足的患者在分娩时催产素分泌显著升高，增强子宫肌收缩力，有助于分娩[1]。患者分娩时子宫收缩可使得腹部剧烈疼痛，不少患者因对分娩疼痛缺乏理性的认识，往往对此充满恐惧及焦虑，导致第一产程延长，以至于影响胎儿的正常分娩[2，3]。研究发现，催产素分泌还受到上述情绪反应的影响，且焦虑、恐惧等不良情绪可降低痛阈，形成阻碍正常分娩的恶性循环[4，5]。芬太尼等麻醉性镇痛药通过激动阿片受体而达到止痛作用，效果显著，且能改善疼痛引起的情绪反应[6]。笔者进行回顾性分析，分别对于采用芬太尼与舒芬太尼镇痛患者的疗效进行对比，且目前国内相关文献较少，现报道如下。, 百拇医药(黄建平 罗新萍 帅晶 彭莎)
[关键词] 芬太尼；舒芬太尼；产科分娩；镇痛
[中图分类号] R714.3 [文献标识码] B [文章编号] 1673-9701(2015)30-0112-03
Comparison of the effect of fentanyl and sufentanil on labor analgesia
HUANG Jianping LUO Xinping SHUAI Jing PENG Sha
Department of Anesthesiology， Ji'an Maternal and Child Health Care Center in Jiangxi Province， Ji'an 343000， China
[Abstract] Objective To observe the effect of fentanyl and sufentanil on labor analgesia， so that theoretical supports to the selection of drugs used for labor analgesia would become available. Methods The 120 diagnosed cases from February 2011 and February 2013 were included in the study and randomly divided into three groups. The 40 patients in group C was not treated with anesthetic analgesia； the 40 patients in group B was administered fentanyl； sufentanil analgesia was applied to the 40 patients in group A. Group A and B received lumbar anesthesia-CSEA and PCA. Observation was made of VAS pain scores， initial administration timing of drug， stages of labor， amount of bleeding， oxytocin， neonatal blood and gas analysis， Apgar scores， and adverse reactions. Results Compared with group B， group A experienced better analgesic effect(P<0.05) and lower VAS pain scores at 5 min and 90 min(P<0.05)， without significant influence on amount of bleeding， neonatal blood and gas analysis， Apgar scores and other indexes(P>0.05). In terms of the application of oxytocin and stages of labor， group A and B significantly differed Group C(P<0.05). group A of adverse reaction occurrence rate was lower(P<0.05). Conclusion Fentanyl and sufentanil are on the obstetric analgesia， has significant inhibitory effect， but sufentanil rapid onset， effect can last for a long time， less adverse reactions， is superior to fentanyl treatment， worthy of promotion.
[Key words] Sufentanil； Fentanyl； Delivery； Analgesia
分娩是大多女性必须经历的过程，子宫条件准备充足的患者在分娩时催产素分泌显著升高，增强子宫肌收缩力，有助于分娩[1]。患者分娩时子宫收缩可使得腹部剧烈疼痛，不少患者因对分娩疼痛缺乏理性的认识，往往对此充满恐惧及焦虑，导致第一产程延长，以至于影响胎儿的正常分娩[2，3]。研究发现，催产素分泌还受到上述情绪反应的影响，且焦虑、恐惧等不良情绪可降低痛阈，形成阻碍正常分娩的恶性循环[4，5]。芬太尼等麻醉性镇痛药通过激动阿片受体而达到止痛作用，效果显著，且能改善疼痛引起的情绪反应[6]。笔者进行回顾性分析，分别对于采用芬太尼与舒芬太尼镇痛患者的疗效进行对比，且目前国内相关文献较少，现报道如下。, 百拇医药(黄建平 罗新萍 帅晶 彭莎)