氢吗啡酮对硬膜外阻滞分娩镇痛时布比卡因最低有效浓度的影响  

The minimum local analgesic concentration of epidural bupivacaine with hydromorphone for labour

作　　者：林雷[1] 陈春[1] 柯齐斌[1] 汤和青[2] 方为[2] 侯俊[2] 

机构地区：[1]三峡大学第一临床医学院麻醉科,湖北宜昌443003 [2]湖北省宜昌市中心人民医院麻醉科,443003

出　　处：《重庆医学》2015年第6期772-774,共3页Chongqing medicine

摘　　要：目的通过建立临床模型研究氢吗啡酮对硬膜外分娩镇痛时布比卡因最低有效镇痛浓度（MLAC）的影响,以探讨第一产程硬膜外镇痛过程中与氢吗啡酮配伍的布比卡因的浓度和剂量。方法选择单胎足月临产妇64例,ASAⅠ~Ⅱ级,均进入第一产程活跃期,分为两组：布比卡因对照组和布比卡因-氢吗啡酮组,每组30例。所有患者于L3~4间隙行硬膜外穿刺置管,以10mL/min的速度分别给予15mL布比卡因注射液和含有200μg氢吗啡酮注射液的布比卡因注射液。根据双盲、序贯的方法,以VAPS作为镇痛标准进行布比卡因适宜浓度的研究。结果 4例临产妇退出研究,余每组30例进入分析。两组布比卡因的MLAC值分别为布比卡因对照组0.103%（95%CI：0.094%~0.113%）;布比卡因-氢吗啡酮组0.044%（95%CI：0.034%~0.053%）,差异有统计学意义（P〈0.05）。两组间Bromage评分,患者心率（HR）、血压（BP）、胎心（FHR）、宫缩强度、不良反应的发生情况差异均无统计学意义（P〉0.05）。结论该研究显示硬膜外腔复合使用氢吗啡酮能显著降低布比卡因的MLAC,氢吗啡酮能安全地应用于硬膜外分娩镇痛。Objective To investigate the minimum local analgesic concentration（MLAC）of epidural hydromorphone combined with bupivacaine for analgesia during the first stage of labor by establishing clinical model.Methods Sixty four labouring parturients at 3-7cm cervical dilation who requested epidural analgesia were allocated to one of two groups.After a lumbar epidural catheter was placed,study participants received 15 mL bupivacaine（n=30）,bupivacaine with hydromorphone 200μg（n=30）.The concentration of bupivacaine was determined by the response of the previous patient using 0-100 mm visual analog pain scores,with≤30mm within 30 min defined as effective.Results Four women were excluded,leaving 30 patients in each of the two groups for analysis.The MLAC of bupivacaine alone was 0.103%（95% CI：0.094%-0.113%）.The addition of hydromorphone at doses of 200μg resulted in significant reduction（P〈0.05）in the MLAC of bupivacaine to 0.044%（95% CI：0.034%-0.053%）,the difference was significant（P〈0.05）.There was no significant difference in Bromage scores,HR,BP,FHR,UC and adverse reaction（P〉0.05）.Conclusion The study showed a significant reduction in the MLAC of bupivacaine by hydromorphone.Hydromorphone could be safely used in epidural analgesia for labor.

关 键 词：氢吗啡酮 布比卡因 分娩 最低有效镇痛浓度 

分 类 号：R714.3[医药卫生—妇产科学]