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鞘内小剂量舒芬太尼对罗哌卡因硬膜外分娩镇痛的影响
The effection of epidural ropivacaine combined with intrathecal low-dose sufentanil injection in labour analgesia

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DOI:
作者:
肖飞1 陈新忠 2徐文平1
Xiao F,Chen XZ,Xu WP
作者单位:
1嘉兴市妇幼保健院 2浙江大学附属妇产科医院
1 JiaXing Maternity and Child Health Care Hospital 2 Women's Hospital School of Medicine Zhejiang University
关键词:
鞘内 舒芬太尼 罗哌卡因 硬膜外 分娩镇痛
intrathecal； epidural； sufentanil； ropivacaine； labor analgesia
摘要:
【摘要】目的 评价鞘内注射5μg舒芬太尼对硬膜外分娩镇痛罗哌卡因半数有效浓度（EC50）的影响。方法 选择初产妇60例，随机分为硬膜外组和腰硬联合组（n=30），两组产妇均于L2-3间隙行硬膜外穿刺并向头侧置管4厘米，其中腰硬联合组在硬膜外置管前鞘内注射5μg的舒芬太尼。两组均注入含0.4μg ml-1舒芬太尼的罗哌卡因10ml。 每组第一例罗哌卡因浓度为0.12%，后续产妇的罗哌卡因浓度根据Dixon序贯法决定。根据Dixon序贯法计算出两组罗哌卡因的EC50。采用视觉模拟评分法（VAS）评价注药产程中疼痛程度，观察产妇麻醉平面、运动阻滞、不良反应及满意度，观察胎心率、新生儿Apgar评分。结果 硬膜外组罗哌卡因的EC50为0.058%，95％CI(0.045%~0.061%)；腰硬联合组EC50为0.035%，95％CI(0.025%~0.041%)，差异有统计学意义（P＜0.05）。与硬膜外组比较，腰硬联合组镇痛后5min的VAS评分明显降低（P＜0.05），低血压、瘙痒的发生率明显增高（P＜0.05），镇痛的满意程度高（P＜0.05）。结论 鞘内注射5μg的舒芬太尼可以明显降低硬膜外罗哌卡因分娩镇痛的EC50。
【Abstract】 Objective To evaluate the effect of intrathecal sufentanil 5μg on the 50% effective concentration (EC50) of epidural ropivacaine for labor analgesia. Methods Sixty nulliparous women were randomly assigned to one of two groups ( n=30 each ): Combined spinal and epidural anesthesia(CSEA) group and epidural anesthesia (EA) group. In addition to that the patients in CSEA group were received 5μg sufentanil intrathecally, all patients in both groups were inserted with an epidural catheter at L2,3 interspace and 4cm cephalad in the epidural space. Each patient received a bolus of 10 ml ropivacaine combined with 0.4μg ml-1 sufentanil. The ropivacaine concentration was 0.12% for the first case in both group. The ropivacaine concentration for the consequent cases were increased or decreased by 0.01% according to up-down sequential method. The Dixon up-down method was used to determine EC50 .Visual analog Score (VAS) for pain, level of sensory blockade, modified Bromage score, the adverse effects and patient satisfaction were recorded. The fetal heart rate and neonatal Apgar scores were monitored. Results The EC50 of epidural ropivacaine for labor analgesia was significantly higher in EA group [0.063% (95% CI, 0.041%~0.081%)] than that in CSEA group [0.044%(95% CI, 0.029%~0.057%)].Compared with group EA, VAS of five minutes after epidural administration were lower, the incidence of pruritus and hypotension were higher, the patient satisfaction scores were also higher in group CSEA. Conclusion Intrathecal sufentanil 5 μg decreases the EC50 of epidural ropivacaine for labor analgesia by about 40%.

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