不同浓度芬太尼对硬膜外罗哌卡因分娩镇痛效应的影响  

Effects of ropivacaine combined with fentanyl for epidural labor analgesia

作　　者：甘树媛[1] 沈晓凤[2] 唐跃 徐建国[1] 

机构地区：[1]南京大学医学院南京军区南京总医院麻醉科,210002 [2]江苏省妇幼保健医院麻醉科 [3]江苏省常州市妇幼保健医院麻醉科

出　　处：《中华麻醉学杂志》2006年第5期421-424,共4页Chinese Journal of Anesthesiology

摘　　要：目的观察不同浓度芬太尼对硬膜外罗哌卡因分娩镇痛效应的影响。方法本研究为多中心、随机、双盲对照研究,选择要求分娩镇痛的初产妇128例,ASA Ⅰ或Ⅱ级,随机分为4组,F0组 (n=33):单纯罗哌卡因组;F1组(n=30):罗哌卡因混合1 μg／ml芬太尼组;F2组(n=33):罗哌卡因混合2μg/ml芬太尼组;F3组(n=32):罗哌卡因混合3μg／ml芬太尼组。所有产妇于L2,3硬膜外穿刺头向置管,注入15 ml药液。各组初始罗哌卡因浓度为0．12％,其后每例产妇所用浓度按双盲、序贯法进行调整。以VAS评价产妇注药30 min内镇痛效果,计算硬膜外罗哌卡因分娩镇痛的半数有效浓度 (EC50),记录注药后30 min产妇收缩压、心率及胎儿心率、运动阻滞程度及不良反应发生情况。结果共有124例完成试验观察。各组硬膜外罗哌卡因分娩镇痛的EC50,及其95％可信区间(95％CI)为: F0组:0．110％及0．1090％-0．1116％;F1组:0．089％及0．0877％-0．0911％;F2组:0．073％及0． 0717％-0．0744％;F3组:0．060％及0．0560％-0．0634％,F1、F2、F3组EC50低于F0组(P<0．01)。硬膜外注药后30 min内,产妇心率、血压、胎儿心率均在正常范围,各组运动阻滞程度比较差异无统计学意义(P>0．05);与F0组比较,F3组皮肤瘙痒发生率升高(P<0．05)。结论硬膜外混合低浓度芬太尼(1-3μg／ml)能增强0.12％罗哌卡因分娩镇痛效果,推荐芬太尼的安全浓度范围为1-2μg/ml。Objective To evaluate effects of ropivacaine combined with different concentrations of fentanyl for epidural labor analgesia. Methods In this multicenter double-blinded randomized study 128 parturients at full term and 2-3 cm of cervical dilatation who requested epidural analgesia were randomly allocated to one of 4 groups ： group F0 received epidural ropivacaine alone （ n = 33） ; group F1 received epidural ropivacaine with fentanyl 1μg·ml^-1（n = 30） ; group F2 epidural ropivacaine ＋ fentanyl 2μg·ml^-1 （ n = 33） and group F3 epidural ropivacaine ＋ fentanyl 3μg·ml^-1 （ n = 32）. Epidural catheter was placed at L2.3 and advanced 4 cm into the epidural space in cephalad direction. A bolus of 15 ml of ropivacaine alone or with fentanyl was given after correct epidural placement was confirmed. EC50 of epidural ropivacaine was determined by up-and-down sequential experiment. The initial concentration of epidural ropivacaine was 0.12%. If effective the next parturient received ropivacaine of lower concentration; if ineffective the ropivacaine concentration was increased. Each time the concentration of epidural ropivacaine increased/decreased by 0.01% . The analgesia was assessed using VAS score （0-10 0 = no pain, 10 = worst pain）. If VAS score was less than 3 within 30 rain of ropivacaine administration, analgesia was defined as effective. EC50 of ropivacaine was calculated according to Dixon and Massey. Results Four of the 128 parturients enrolled were excluded because of uncertain results of interrupted observation. The EC50 of epidural ropivacaine for labor analgesia and the 95% confidence interval （95% CI） of EC5o were 0. 110% （95% CI 0.109 0%-0.111 6%） in group F0; 0.089% （95% CI0.0877%-0.091 1%） in group F1; 0.073% （95% CI 0. 071 7%-0.074 4%） in group F2 and 0.060% （95% CI 0.056 0%-0.634%） in group F3 respectively. The EC50 was significantly higher in group F0 than in group F1, F2 and F3 （ P 〈 0. 05 ）. There was no significant decrease in SP within 30 min af

关 键 词：芬太尼 酰胺类 镇痛 产科 剂量效应关系 药物 

分 类 号：R714.3[医药卫生—妇产科学]