Francke A, Frahm R
Klinik für Anästhesiologie und Intensivtherapie, Wilhelm-Pieck-Universität Rostock.
Zentralbl Gynakol. 1988;110(4):215-23.
Modern obstetrics should include not only an optimal labour monitoring but also an adequate pain relief during delivery. Due to the discovery of specific opiate receptors, for example in the substantia gelatinosa of the posterior horn in the spinal cord and the proof of direct pain-modifying effects on spinal level, new ways of the therapy of pain have been developed. The analysis was made with 40 parturients, who had decided for an epidural analgesia. They were given 0.1 mg fentanyl epidurally at a cervical dilatation of 3 to 5 cm and regular uterine contractions. The registrated onset time of fentanyl was between 6 and 15 minutes. A fentanyl dose of 0.1 mg applied epidurally proved to be sufficient for all parturients for the alleviation of pain in the period of dilatation. The interval without pain amounted to 130 mins. The motoricity was not impaired by the peridural application of fentanyl, because the parturient was able to be mobilized under continuous telemetric monitoring including telemetric management of the profile of the uterine activity. The period of the active and latent phases as well as the total delivery time was within the desirable ranges. An impairment of the general condition, e.g. vomiting, nausea or pruritus, was not noticed. There were no circulatory disturbances either. After the application of fentanyl the cardiotocograms remained uninfluenced in all parameters. All parturients declared that they had a positive birth experience under this kind of obstetric analgesia and that they would decide for this method again in case of a further delivery.
现代产科学不仅应包括最佳的产程监测,还应包括分娩期间充分的疼痛缓解。由于发现了特定的阿片受体,例如脊髓后角胶状质中的受体,并证明了其对脊髓水平有直接的疼痛调节作用,因此开发了新的疼痛治疗方法。对40名决定采用硬膜外镇痛的产妇进行了分析。在宫颈扩张3至5厘米且有规律宫缩时,给她们硬膜外注射0.1毫克芬太尼。记录到芬太尼的起效时间在6至15分钟之间。硬膜外注射0.1毫克芬太尼的剂量被证明对所有产妇在扩张期缓解疼痛都足够。无痛间隔时间达130分钟。硬膜外应用芬太尼并未损害运动能力,因为产妇在包括子宫活动曲线的遥测管理在内的连续遥测监测下能够活动。活跃期和潜伏期以及总分娩时间均在理想范围内。未发现一般状况受损,例如呕吐、恶心或瘙痒。也没有循环系统紊乱。应用芬太尼后,所有参数的胎心宫缩图均未受影响。所有产妇均表示在这种产科镇痛下有积极的分娩体验,并且如果再次分娩,她们会再次选择这种方法。