使用麻醉镇痛药芬太尼纠正违反分娩自主调节

A. Zhezher, N. Zhezher
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摘要

背景。在低张力分娩的情况下,有效的延长硬膜外镇痛(PEA)的问题仍然没有解决,它允许对分娩活动过程进行最小的干预,同时提供足够的镇痛。一项研究是为了提高低渗分娩妇女在分娩第一阶段使用PEA的有效性。目的:提高阴道分娩时低张力分娩时延长硬膜外镇痛的有效性。材料和方法。我们对60例诊断为1期低渗分娩的妇女进行了镇痛,将她们分为两组:主要组(n = 35)和对照组(n = 25)。两组ASA均为I-II级。两组均在L1-L2处穿刺硬膜外间隙。给予2%利多卡因溶液4 ml试验剂量,5分钟后插入硬膜外导管。主组在硬膜外腔内注射芬太尼溶液1 ml和0.9% NaCl 6 ml;对照组:0.125%布比卡因溶液6 - 8ml。根据视觉模拟评分、血流动力学变化和分娩结果(保守或手术)评估疗效。根据心脏造影资料评估胎儿状况。使用Excel对材料进行统计处理。结果。69%的病例使用芬太尼保守地完成了分娩,胎儿和新生儿的情况被认为是令人满意的。在对照组中,72%的分娩结果为剖宫产。手术指征为低张力分娩和胎儿窘迫。结论。麻醉镇痛药芬太尼用于低张力分娩时的长时间硬膜外镇痛,可有效减轻疼痛,增加保守分娩的可能性。对母亲、胎儿和新生儿是安全的。
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Use of the narcotic analgesic fentanyl to correct violations of the autonomic regulation of childbirth
Background. The problem of effective prolonged epidural analgesia (PEA) in case of hypotonic labor, which allows minimal intervention in the process of labor activity while providing adequate analgesia, remains unresolved. A study was conducted to increase the effectiveness of PEA use during the first state of childbirth in women with hypotonic labor. The purpose: to increase the effectiveness of prolonged epidural analgesia in case of hypotonic labor during vaginal childbirth. Materials and methods. We performed analgesia to 60 women with a diagnosis of stage 1 hypotonic labor who were divided in 2 groups: the main one (n = 35) and the controls (n = 25). ASA status in both groups was I–II. In both groups, the epidural space was punctured at L1-L2. A test 4-ml dose of 2% lidocaine solution was administered and 5 minutes after, the epidural catheter was inserted. Then, in the main group, 1 ml of fentanyl solution and 6 ml of 0.9% NaCl were injected into the epidural space; in the control group, 6–8 ml of 0.125% bupivacaine solution. The effectiveness was evaluated according to the visual analogue scale, hemodynamic changes and the outcome of childbirth (conservative or operative). The condition of the fetus was assessed according to cardiotocography data. Statistical processing of the material was carried out using Excel. Results. The use of fentanyl in 69 % of cases allowed finishing the birth conservatively, the condition of the fetus and newborn was considered satisfactory. In the control group, 72 % of births resulted in cesarean section. Indications for surgery were hypotonic labor and fetal distress. Conclusions. The use of the narcotic analgesic fentanyl for prolonged epidural analgesia in hypotonic labor effectively relieves pain and increases the likelihood of conservative childbirth. It is safe for mother, fetus and newborn.
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