不同浓度舒芬太尼或芬太尼对硬膜外罗哌卡因分娩镇痛效应的影响  

Influences of different concentrations of sufentanil or fentanyl on efficacy of epidural ropivacaine for labor analgesin

作　　者：徐建国[1] 沈晓凤 唐跃 陈新中[4] 贾真[5] 甘树媛[6] 金毅[1] 

机构地区：[1]南京军区南京总医院麻醉科,210102 [2]南京市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 [4]浙江大学医学院附属妇产科医院麻醉科 [5]武警河南总队医院麻醉科 [6]浙江大学医学院附属第一医院麻醉科

出　　处：《中华麻醉学杂志》2007年第7期599-602,共4页Chinese Journal of Anesthesiology

摘　　要：目的研究不同浓度舒芬太尼或芬太尼对硬膜外罗哌卡因分娩镇痛效应的影响。方法采用多中心、随机、双盲对照法进行该试验。初产妇224例，ASAⅠ级或Ⅱ级，妊娠≥36周，产前未服用镇痛、催眠药，随机分为7组：单纯罗哌卡因组（Ⅰ组，n=33）、罗哌卡因混合0．2μg／ml舒芬太尼组（Ⅱ组，n=33）、罗哌卡因混合0．4vg／ml舒芬太尼组（Ⅲ组，n=32）、罗哌卡因混合0．6μg／ml舒芬太尼组（Ⅳ组，n=31）、罗哌卡因混合1μg／ml芬太尼组（Ⅴ组，n=32）、罗哌卡因混合2μg／ml芬太尼组（Ⅵ组，n=31）及罗哌卡因混合3μg／ml芬太尼组（Ⅶ组，n=32）。所有产妇宫Vt开至2—3cm时，于L2，3间隙硬膜外穿刺头向置管，分别注人15ml罗哌卡因与不同浓度的舒芬太尼或芬太尼混合药液。各组初始的罗哌卡因浓度为0．12％，采用双盲、序贯法，以上一例产妇的镇痛效果确定下一例产妇所用的罗哌卡因药液浓度。采用视觉模拟评分法（VAS）评价注药30min内的疼痛程度，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30min产妇心率、收缩压及胎儿心率、运动阻滞程度及不良反应的发生情况。结果共有214例完成试验。硬膜外注药后30min内，产妇心率、收缩压及胎胎儿心率均在正常范围内，各组运动程度阻滞程度差异无统计学意义（P〉0．05）；与Ⅰ组比较，Ⅳ组和Ⅶ组不良反应发生率升高（P〈0．05）。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：Ⅰ组0．1100％及0．1057％-0．1159％，Ⅱ组0．0741％及0．0708％．0.0789％，Ⅲ组0．0474％及0.0405％-0．0556％，Ⅳ组0．0355％及0．0289％-0．0438％，Ⅴ组0.0890％及0．0877％．0．0911％，Ⅵ组0．0730％及0．0717％-0．0744％，Ⅶ组0．0610％及0．0560％-0．0635％；Ⅱ-Ⅶ组EC50低于Ⅰ组（P〈0.05）；与Ⅱ组、Ⅵ组Objective To evaluate effects of ropivacaine combined with different concentrations of sufentanil or fentanyl for epidural labor analgesia. Methods In this muhicenter double-blinded randomized study , 224 parturients at full term and 2-3 cm of cervical dilatation who requested epidural analgesia were randomly allocated to one of 7 groups： group Ⅰ received epidural ropivacaine alone （ n = 33 ）, group Ⅱ received epidural ropivacaine ＋ sufentanil 0.2 μg/ml （ n = 33）, group Ⅲ epidural ropivacaine ＋ sufentanil 0.4 μg/ml （ n = 32）, group Ⅳ epidural ropivacaine ＋ sufentanil 0.6 μg/ml （ n = 31） ,group Ⅴ epidural ropivacaine ＋ fentanyl 1 μg/ml （ n = 32） ,group Ⅵ epidural ropivacaine ＋ fentanyl 2 μg/ml （ n = 31） and group Ⅶ epidural ropivacaine ＋ fentanyl 3 μg/ml （ 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 sufentanil or fentanyl was given after correct epidural placement was confirmed. EC50 of epidural ropivacaine was determined by up-and-down sequential method. 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 min of ropivacaine administration, analgesia was defined as effective. EC50 of ropivacaine was calculated according to Dixon and Massey. Results Ten of the 224 parturients enrolled were excluded because of uncertain results of interrupted observation. SP , heart rates of the parturient and fetuses were maintained in normal range within 30 min after ropivacaine administration in 7 groups. The incidence of side-effect was significantly higher in group Ⅳ and Ⅶ than in group Ⅰ （ P 〈 0.05

关 键 词：舒芬太尼 芬太尼 酰胺类 镇痛 产科 剂量效应关系 药物 

分 类 号：R686[医药卫生—骨科学]