Li Jiexiong, Cai Jiachun, Li Jianjin, Li Zhitao
Department of Anesthesiology, Peking University Shenzhen Hospital, Shenzhen, People's Republic of China.
Department of Fundus Disease, Shenzhen Eye Hospital, Shenzhen, People's Republic of China.
Int Med Case Rep J. 2023 Oct 11;16:673-678. doi: 10.2147/IMCRJ.S432093. eCollection 2023.
Worrying about increasing the use of instrument-assisted delivery and prolonging the process, midwives in our institution tended to persuade the parturients who had entered the second stage of labor, to give up neuraxial analgesia. Remifentanil seemed to be suitable for this situation due to its advantages of fast onset and metabolism. We designed a single arm and prospective study to explore the analgesic effect and safety of remifentanil intravenous patient-controlled analgesia (PCA) in singleton parturients during the second stage of labor.
Ten pregnancies were included, whose cervical dilation had exceeded 8 cm when they arrived into the delivery room. The patient was given 40 μg remifentanil intravenously as soon as she felt the contraction with a lockout time of 2 minutes. The maternal heart rate (MHR), mean arterial pressure (MAP), SpO2, fetal heart rate (FHR), OAA/S score, and VAS analgesia score were recorded before and at 5, 10, 20, 30, and 60 minutes after administration. An umbilical artery blood gas analysis and Apgar scores at 1 and 5 minutes were also recorded after the delivery of the newborn. The incidence of adverse events and overall satisfaction with analgesia were recorded.
The VAS score decreased from 9.2 to 4.6 after remifentanil administration. All umbilical artery PH values were beyond 7.20. All 1-minute newborns' Apgar scores were 8 points or greater, and 9 points or greater in the 5th minute. Adverse events included 3 cases of dizziness, 3 cases of nausea, 1 case of vomiting, and 1 case of parturients had a transient FHR drop at the 10th minute, accompanied by hypoxemia and hypersomnia. The overall satisfaction rate was 70%.
Remifentanil PCA could effectively relieve the severe uterine contraction pain suffered by the parturients in the second stage of labor with safety.
由于担心增加器械助产的使用并延长产程，我院助产士倾向于劝说已进入第二产程的产妇放弃椎管内镇痛。瑞芬太尼因其起效快和代谢快的优点似乎适用于这种情况。我们设计了一项单臂前瞻性研究，以探讨瑞芬太尼静脉自控镇痛（PCA）在单胎产妇第二产程中的镇痛效果和安全性。
纳入10例妊娠，产妇进入产房时宫颈扩张已超过8cm。产妇一旦感到宫缩，立即静脉给予40μg瑞芬太尼，锁定时间为2分钟。记录给药前及给药后5、10、20、30和60分钟时的产妇心率（MHR）、平均动脉压（MAP）、SpO₂、胎儿心率（FHR）、OAA/S评分和VAS镇痛评分。新生儿出生后还记录脐动脉血气分析结果及1分钟和5分钟时的阿氏评分。记录不良事件发生率和镇痛总体满意度。
瑞芬太尼给药后VAS评分从9.2降至4.6。所有脐动脉pH值均超过7.20。所有新生儿1分钟时的阿氏评分均为8分或以上，5分钟时为9分或以上。不良事件包括3例头晕、3例恶心、1例呕吐，1例产妇在第10分钟时出现短暂胎儿心率下降，伴有低氧血症和嗜睡。总体满意率为70%。
瑞芬太尼PCA能有效缓解产妇第二产程中严重的子宫收缩疼痛，且安全。
