摘要背景 静脉输注瑞芬太尼(remifentanil,REM)实行分娩镇痛日益受到关注,但若处理不当可对母婴安全性提出挑战,限制了其临床应用. 目的 为在临床实践中进一步优化REM用于静脉分娩镇痛提供参考. 内容 从REM的药理学特性入手,分析总结该药在不同静脉给药模式下分娩镇痛的疗效和安全性,对其在国内、外的应用现状与研究进展进行文献综述. 趋向 REM实施静脉分娩镇痛能获得较高的满意度,但不推荐临床常规应用,尚需对其安全性和有效性进行深入研究.

abstractsBackground Intravenous infusion of remifentanil (REM) is commonly used for labor analgesia. However, its appropriate usage poses challenges in obstetrics which requires balancing analgesia sufficiency and safety of mothers and neonates. Objective The purpose of this review is to provide information to optimize intravenous administration of REM for labor analgesia. Content Rapid onset, fast clearance, and non-effect on uterine contraction are demanding properties of analgesics to reduce suffering of puerperants during labor.Either pethidine or inhaled anesthetics has adverse effects on neonates and mothers. Intrathecal analgesia has minor effects on neonates but may cause low back pain in mothers. REM has many beneficial pharmacological properties, such as, high potency and selectivity to μ-opioid receptors, high lipophilicity, and fast metabolism. Compared with other analgesics, REM has better analgesia efficiency and higher levels of satisfaction. It is, however, not rarely reported that REM has similar side-effects as other opioid agents, such as, nausea, vomiting, muscle stiffness, and respiration and circulation inhibition, etc. Note that these side-effects of REM are dose-dependent and can be reversed by adjusting drug administration. Therefore, real-time monitoring of respiratory parameters, etc. is necessary to use remifentanil for labor analgesia. Trend Intravenous administration of REM for labor analgesia can obtain high degree of satisfaction, but further investigations are warranted to evaluate its safety and effectiveness before it is routinely applied in clinical practice.