Süğür Tayfun, Kızılateş Esra, Kızılateş Ali, İnanoğlu Kerem, Karslı Bilge
Health Sciences University, Antalya Training and Research Hospital, Anesthesiology and Reanimation Clinic, Antalya, Turkey.
VKV Medamerikan Medical Center, İstanbul, Turkey.
Agri. 2020 Jan;32(1):8-18. doi: 10.14744/agri.2019.35403.
In our study, patient controlled epidural analgesia (PCEA) and patient controlled intravenous remifentanil analgesia (PCIVA) were compared for VAS, and also their side effects on mother and newborn.
In this study, 37 pregnant women with a single fetus, who had labor analgesia, were divided into groups of PCIVA (Group 2) and PCEA (Group 1). Bupivacaine 1.25 mg/ml and fentanyl 2 mcg/ml in 100 ml epidural solution were prepared for Group 1. The infusion dose was 15 ml, 5 ml divided doses. We set 5 ml/h basal infusion, 5 ml patient-controlled bolus and 20 min lock time. We prepared 2 mg remifentanil in 100 ml intravenous solution for Group 2. We set 20 mcg/h infusion, 0.05mcg/kg patient-controlled bolus and five min lock time. VAS, maternal-fetal heart rate, blood pressure, oxygen saturation, nausea-vomiting and sedation were recorded during labor. We recorded Apgar scores and maternal satisfaction at the end of labor.
The findings showed that both groups could provide adequate analgesia. However, VAS scores were higher in Group PCIVA. The mother satisfaction and newborn's Apgar scores were similar. In both groups, desaturation, which is requiring oxygen support, was not determined. The oxygen saturations were lower in Group 2. The side effects and patient satisfaction were similar in both groups.
Although PCIVA was found to be satisfactory concerning maternal satisfaction, VAS after 2nd hour were higher compared to PCEA. PCEA is the gold standard in labor analgesia. However, we believe that PCIVA is a good alternative to epidural analgesia in cases where epidural analgesia is contraindicated or where the patient does not want an epidural.
在我们的研究中，比较了患者自控硬膜外镇痛（PCEA）和患者自控静脉瑞芬太尼镇痛（PCIVA）的视觉模拟评分（VAS），以及它们对母亲和新生儿的副作用。
在本研究中，37例接受分娩镇痛的单胎孕妇被分为PCIVA组（第2组）和PCEA组（第1组）。为第1组配制含1.25mg/ml布比卡因和2mcg/ml芬太尼的100ml硬膜外溶液。输注剂量为15ml，分剂量为5ml。我们设定基础输注速度为5ml/h，患者自控推注剂量为5ml，锁定时间为20分钟。为第2组配制含2mg瑞芬太尼的100ml静脉溶液。我们设定输注速度为20mcg/h，患者自控推注剂量为0.05mcg/kg，锁定时间为5分钟。在分娩期间记录VAS、母婴心率、血压、血氧饱和度、恶心呕吐和镇静情况。在分娩结束时记录阿普加评分和母亲满意度。
结果显示两组均能提供充分的镇痛。然而，PCIVA组的VAS评分更高。母亲满意度和新生儿阿普加评分相似。两组均未发现需要氧气支持的低氧血症。第2组的血氧饱和度较低。两组的副作用和患者满意度相似。
虽然发现PCIVA在母亲满意度方面令人满意，但与PCEA相比，第2小时后的VAS更高。PCEA是分娩镇痛的金标准。然而，我们认为在硬膜外镇痛禁忌或患者不希望采用硬膜外镇痛的情况下，PCIVA是硬膜外镇痛的一个良好替代方案。
