改良序贯法测定氢吗啡酮用于潜伏期硬膜外分娩镇痛的半数有效剂量  

Half effective dose of epidural hydromorphone for labor analgesia in latent phase using modified Dixon’s up-and-down sequential allocation method

作　　者：张素素 毛毛[1] 李彩娟[1] 沈晓凤[1] 徐世琴[1] ZHANG Susu;MAO Mao;LI Caijuan;SHEN Xiaofeng;XU Shiqin(Department of Anesthesiology,Women′s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,210004

出　　处：《临床麻醉学杂志》2020年第6期552-554,共3页Journal of Clinical Anesthesiology

摘　　要：目的测定氢吗啡酮用于潜伏期硬膜外分娩镇痛的半数有效剂量(ED50)和90%有效剂量(ED90)。方法选择接受硬膜外分娩镇痛的单胎初产妇28例,年龄25~45岁,BMI 19~29 kg/m2,ASAⅠ或Ⅱ级,宫口扩张≤3 cm。所有产妇于L2-L3间隙行硬膜外腔穿刺并置管,推注氢吗啡酮10 ml。每例产妇所接受的氢吗啡酮剂量按序贯法确定,相邻药物剂量比值为1∶1.2。首例产妇硬膜外注射氢吗啡酮0.4 mg,若VAS疼痛评分≤3分,则下一例产妇接受的氢吗啡酮降低一个剂量梯度;若VAS疼痛评分>3分,则下一例产妇上升一个剂量梯度。记录给药前(T0)及给药后10 min(T1)、20 min(T2)、30 min(T3)时的VAS疼痛评分。计算氢吗啡酮用于潜伏期硬膜外分娩镇痛的ED50和ED90及其95%可信区间(CI)。记录循环抑制、呼吸抑制、恶心呕吐、皮肤瘙痒、寒颤等不良反应的发生情况。结果氢吗啡酮用于潜伏期硬膜外分娩镇痛的ED50为0.237 mg(95%CI 0.206~0.271 mg),ED90为0.479 mg(95%CI 0.320~0.717 mg)。1例产妇出现皮肤轻度瘙痒,无其他不良反应发生。结论氢吗啡酮用于潜伏期硬膜外分娩镇痛的ED50为0.237 mg(95%CI 0.206~0.271 mg),ED90为0.479 mg(95%CI 0.320~0.717 mg),不良反应少,起效时间快。Objective To determine the half effective dose(ED50) and 90% effective dose(ED90) of epidural hydromorphone for labor analgesia in latent phase. Methods Twenty-eight single-fetal primiparas receiving epidural analgesia, aged 25-45 years, with a BMI of 19-29 kg/m2, falling into ASA physical status Ⅰ or Ⅱ, were enrolled in this study. The cervical dilatation of all parturients was ≤ 3 cm when they required analgesia. After a lumbar epidural catheter was placed at the L2-L3 interspace, 10 ml hydromorphone was injected. The dose of hydromorphone was determined by sequential method, and the adjacent drug dose ratio was 1∶1.2. The initial dose of hydromorphone injected was 0.4 mg. If a patient was reported with a VAS ≤ 3 scores, the subsequent dose was decreased. If a patient was reported with a VAS > 3 scores, the subsequent dose was increased. VAS scores during contractions were recorded before(T0) and 10 min(T1), 20 min(T2), and 30 min(T3) after administration. The ED50 and ED90 and corresponding 95% confidence interval(CI) of epidural hydromorphone for labor analgesia in latent phase were calculated. The adverse reaction of primiparas was recorded. The occurrence of adverse reactions such as circulation inhibition, respiratory depression, nausea and vomiting, skin itching and chills were recorded. Results The ED50 and ED90 of hydromorphone was 0.237 mg(95% CI 0.206-0.271 mg) and 0.479 mg(95% CI 0.320-0.717 mg), respectively. One patient experienced mild pruritus. No other complications occurred. Conclusion The ED50 and ED90 of epidural hydromorphone for labor analgesia in latent phase is 0.237 mg and 0.479 mg. The adverse reactions are few and the onset time is fast.

关 键 词：分娩镇痛 氢吗啡酮 硬膜外 半数有效剂量 90%有效剂量 

分 类 号：R714.3[医药卫生—妇产科学]