三种不同浓度的芬太尼用于产妇自控分娩镇痛的比较  

A clinical comparison of three different concentration of fentanyl with patient controlled epidural analgesia during labor.

作　　者：李新华[1] 李世忠[1] 申树先[1] 

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《华中医学杂志》2004年第6期357-358,360,共3页Central China Medical Journal

摘　　要：目的　比较三种不同浓度芬太尼的镇痛效果 ,并探讨其有效性、安全性。方法　将 80例产妇随机分为四组 ,每组各 2 0例。A组 0 .0 6 2 5 %布比卡因 +3μg/ml芬太尼 ;B组0 .0 6 2 5 %布比卡因 +4μg/ml芬太尼 ;C组0 .0 6 2 5 %布比卡因+5 μg/ml芬太尼 ;D组为对照组。分别观测用药前、用药后 15min及 6 0min、宫口开全时、胎儿娩出时产妇的血压 (Bp)、心率 (HR)、呼吸频率 (RR)、脉搏血氧饱和度 (SpO2 )、胎儿心率 (FHR)、30min进行视觉模拟评分 (VAS)及镇静评分 (SS)。结果　①各组SS均在 0～ 1分 ,产妇的DBp、R、HR、SpO2 及FHR无明显变化 ,组间无统计学差异 ,未发现呼吸抑制。②镇痛组VAS给药后开始下降 ,其中B组较其它各组下降显著 (P <0 .0 5 )。分娩镇痛的效果最好。③各组总产程无显著性差异。结论　芬太尼 4 μg/ml联合0 .0 6 2 5 %布比卡因用于自控硬膜外镇痛分娩镇痛效果最佳 ,副作用少 。Objective Three different concentrations of fentanyl and bupivacaine were administered for patient during labor to evaluate their efficiency and safety, and to compare their analgesic effect.Methods 80 nulliparous full-term parturients were randomly divided into four groups.Ther werw 20 patients in every group. Group A 0.0625% bupivacaine+3μg/ml fentanyl; Group B 0.0625% bupivacaine +4μg/ml fentanyl; Group C 0.0625% bupivacaine +5μg/ml fentanyl; Group D was contrast group. Maternal blood pressure (BP), heart rate (HR), respirtory rate (RR) and fetal heart rate (FHR) and pulse oximtry (SpO 2) were recorded before the drug was administered, after the durg was administered 15min and 60min respectively, when the cervix was dilated fully and when the second stage of labor was over. Parturients were interviewed evey 30min during labor. At the same time visual analogue scale (VAS) and sedation score (SS) were recorded.Results 1. SS were between o to 1 in all groups. The BP, HR, RR, SpO 2 of the parturients and FHR have to statistical differences in all groups. No respiratory depression was observed. 2. VAS declined after the drug administered. Compared with the other groups, the group B declined obviously. The analgesia efficiency was the best. 3. The whole stage of labor did not differ among groups.Conclusion This study suggests that fentanyl 4μg/ml+0.0625% bupivacaine which administered for patient controlled epidural analgesia during labor is safe and effective, with minimal side-dffects for parturients and fetal.

关 键 词：芬太尼 布比卡因 产妇 分娩镇痛 SPO2 VAS 脉搏血氧饱和度 发现 呼吸频率 变化 

分 类 号：R714.3[医药卫生—妇产科学]