Solek-Pastuszka Joanna, Zagrodnik-Ulan Edyta, Bohatyrewicz Romuald, Celewicz Zbigniew
Chair and Department of Anaesthesiology and Intensive Therapy, Pomeranian Medical University in Szczecin, Poland.
Anaesthesiol Intensive Ther. 2015;47(1):82-6. doi: 10.5603/AIT.2015.0008.
Labour is thought to be one of the most intense and painful experiences in a woman's life. Numerous studies using a Visual Analogue Scale invariably demonstrate that 20% of women in labour describe the pain as "unbearable" and 60% describe the pain as "very intense". Since the mid-1980s, continuous epidural analgesia during labour has been considered the gold standard of labour anaesthesia and is currently the most frequently used. There are situations in which this type of analgesia could not be used. An alternative pain management is administration of parenteral opioids, the most frequently used of which is pethidine. Its use is associated with adverse effects and unsatisfactory analgesia. Since the second half of the 20th century, a new generation of opioids, such as fentanyl or remifentanil, has been used. Despite their much better pharmacokinetic and pharmacodynamic parameters, obstetricians, midwives and neonatologists are most aware of pethidine, probably because it has been used for the longest period of time, despite its disadvantages and the risk that its use entails. The drug that is nearest to ideal is remifentanil. The countries in which it is widely used as an alternative type of labour anaesthesia have developed practice standards or guidelines practice. Guidelines and alternatives to pethidine protocols for effective labour analgesia in Poland might be merited.
分娩被认为是女性一生中最强烈、最痛苦的经历之一。众多使用视觉模拟评分法的研究始终表明，20%的分娩女性将疼痛描述为“无法忍受”，60%的女性将疼痛描述为“非常剧烈”。自20世纪80年代中期以来，分娩期间持续硬膜外镇痛一直被视为分娩麻醉的金标准，目前也是使用最频繁的方法。在某些情况下，这种类型的镇痛无法使用。一种替代的疼痛管理方法是注射阿片类药物，其中最常用的是哌替啶。其使用与不良反应和镇痛效果不理想有关。自20世纪下半叶以来，新一代阿片类药物，如芬太尼或瑞芬太尼，已被使用。尽管它们的药代动力学和药效学参数要好得多，但产科医生、助产士和新生儿科医生最熟悉哌替啶，可能是因为尽管它有缺点且使用存在风险，但它使用的时间最长。最接近理想的药物是瑞芬太尼。在那些它被广泛用作替代分娩麻醉类型的国家，已经制定了实践标准或指南。波兰或许有必要制定有效分娩镇痛的哌替啶方案指南及替代方案。
