序贯法测定氢吗啡酮用于潜伏期硬膜外分娩镇痛罗哌卡因最低有效浓度  

Minimum local analgesic concentration of Ropivacaine combined with Hydromorphone for epidural labor analgesia during incubation period using sequential allocation method

作　　者：王克功 汪海金 张振 罗辉宇 WANG Kegong;WANG Haijin;ZHANG Zhen;LUO Huiyu(Department of Anesthesiology,Xiangyang NO.1 People’s Hospital,Affiliated Hospital of Hubei University of Medicine,Hubei Province,Xiangyang,441000,China)

机构地区：[1]湖北医药学院附属襄阳市第一人民医院麻醉科,湖北襄阳441000

出　　处：《中国医药导报》2021年第31期119-122,共4页China Medical Herald

基　　金：湖北省卫生健康委员会指导性项目(WJ2019F074)。

摘　　要：目的测定氢吗啡酮用于潜伏期硬膜外分娩镇痛时罗哌卡因最低有效浓度(MLAC)和90%有效浓度(EC90)。方法选择2019年6月至2020年1月湖北医药学院附属襄阳市第一人民医院的单胎初产妇30例为研究对象。所有产妇均进入第一产程潜伏期,选择L_(2-3)行硬膜外分娩镇痛,给予罗哌卡因与15μg/ml氢吗啡酮混合液10 ml。采用改良序贯法增减罗哌卡因浓度,初始浓度为0.07%,浓度梯度为0.01%。采用视觉模拟评分法(VAS)判断镇痛是否有效。VAS评分≤3分,下一患者降低一个浓度梯度;VAS评分>3分,给予0.1%罗哌卡因与0.5μg/ml舒芬太尼混合液6 ml补救后VAS评分≤3分,则下一患者升高一个浓度梯度;VAS评分>3分且经补救后VAS评分>3分,则本例剔除,下一患者重复本浓度。记录注药前,注药后5、15、30 min的VAS评分。采用概率单位回归分析计算罗哌卡因的MLAC和EC90。结果氢吗啡酮用于潜伏期硬膜外分娩镇痛罗哌卡因的MLAC为0.035%,EC90为0.049%。结论氢吗啡酮用于硬膜外分娩镇痛时罗哌卡因的MLAC为0.035%,EC90为0.049%,镇痛起效快,不良反应少。Objective To determine the minimum local analgesic concentration(MLAC)and 90%effective concentration(EC90)of Ropivacaine combined with Hydromorphone for epidural labor analgesia during latent period.Methods Thirty cases of singleton primiparous admitted to Xiangyang NO.1 People’s Hospital,Affiliated Hospital of Hubei University of Medicine from June 2019 to January 2020 were selected as study objects.All parturients entered the incubation period of the first stage of labor,L_(2-3) was selected for epidural labor analgesia,and 10 ml of Ropivacaine mixed with 15μg/ml Hydromorphone was given.According to the modified sequential allocation method to increase or decrease the concentration of Ropivacaine,the initial concentration was 0.07%,the concentration gradient was 0.01%.Visual analogue scale(VAS)was used to evaluate the analgesia effect.If VAS score≤3 points,the next patient was reduced a concentration gradient;if VAS score>3 points,after giving 6 ml of dose 0.1%Ropivacaine mixed with 0.5μg/ml Sufentanil to remedy and VAS score≤3 points,the following one patient was increased a concentration gradient;if after giving remedy drugs and VAS score>3 points,this case was eliminated,and the next patient was repeated this concentration.VAS score during contractions were recorded before injection,5,15,and 30 min after injection.MLAC and EC90 of Ropivacaine were calculated by probability unit regression analysis.Results MLAC of Ropivacaine combined with Hydromorphone for epidural labor analgesia in incubation period was 0.035%,and EC90 was 0.049%.Conclusion MLAC of Ropivacaine combined with Hydromorphone for epidural labor analgesia in incubation period is 0.035%,and EC90 is 0.049%,it can be safely used for epidural labor analgesia with fast analgesic effect and few adverse reactions.

关 键 词：氢吗啡酮 分娩镇痛 罗哌卡因 最低有效浓度 90%有效浓度 

分 类 号：R614.42[医药卫生—麻醉学]