Smith C V, Rayburn W F, Allen K V, Bane T M, Livezey G T
Department of Obstetrics and Gynecology, University of Nebraska College of Medicine, Omaha, USA.
J Matern Fetal Med. 1996 Mar-Apr;5(2):89-92. doi: 10.1002/(SICI)1520-6661(199603/04)5:2<89::AID-MFM8>3.0.CO;2-M.
The short-acting opioid fentanyl has been shown to be a useful analgesic during labor. The purpose of this prospective, comparative investigation was to determine whether fentanyl influenced fetal biophysical parameters during labor. Twenty-four uncomplicated pregnancies at 37-41 weeks were studied during the early active phase of labor. Those patients who requested analgesia (study group) were given a standard 50-micrograms dose of fentanyl intravenously. The study (N = 12) and control (N = 12) groups were similar in maternal age, parity, and gestational age distribution. Fetal body and breathing movements and heart rate patterns were evaluated continuously for 80 min at 10-min epochs. Unlike the control group, fetuses exposed to fentanyl had fewer body movements between contractions (P < 0.03) and spent less overall time moving (P < 0.02). Breathing was abolished at 10 min postdosing in all fetuses exposed to fentanyl but not in the control group. The FHR beat-to-beat variability was reduced between contractions for the first 30 min in 8 (66%) of study cases and none of the control cases (P < 0.01). A sine wave-like FHR pattern was observed for 30 min in two fetuses exposed to fentanyl. All infants had 1- and 5-minute Apgar scores > 6, an umbilical artery pH > 7.20, and no need for resuscitation. In conclusion, an intravenous dose of fentanyl during early active labor was associated with temporary depressant effects on many fetal biophysical parameters without apparent harm being observed at delivery.
短效阿片类药物芬太尼已被证明在分娩期间是一种有效的镇痛药。这项前瞻性比较研究的目的是确定芬太尼在分娩期间是否会影响胎儿生物物理参数。对24例孕37 - 41周的无并发症妊娠产妇在分娩早期活跃期进行了研究。那些要求镇痛的患者（研究组）静脉注射了标准剂量50微克的芬太尼。研究组（N = 12）和对照组（N = 12）在产妇年龄、产次和孕周分布方面相似。以10分钟为一个时段，连续80分钟评估胎儿的身体活动、呼吸运动和心率模式。与对照组不同，接触芬太尼的胎儿在宫缩间歇期的身体活动较少（P < 0.03），且总体活动时间较短（P < 0.02）。所有接触芬太尼的胎儿在给药后10分钟呼吸停止，而对照组未出现这种情况。在研究组的8例（66%）病例中，给药后的前30分钟宫缩间歇期的胎心率逐搏变异度降低，而对照组无一例出现这种情况（P < 0.01）。在2例接触芬太尼的胎儿中观察到30分钟的正弦波样胎心率模式。所有婴儿的1分钟和5分钟阿氏评分均> 6，脐动脉pH > 7.20，且无需复苏。总之，在分娩早期活跃期静脉注射芬太尼会对许多胎儿生物物理参数产生暂时的抑制作用，但在分娩时未观察到明显危害。
