摘要
目的 测定产妇硬膜外分娩镇痛时不同浓度舒芬太尼混合罗哌卡因的半数有效浓度（EC50），寻找舒芬太尼混合罗哌卡因的适宜浓度。方法 100例ASAⅠ或Ⅱ级的足月初产妇，妊娠37—42周，随机分为2组：0．4μg／ml舒芬太尼混合罗哌卡因组（A组）（n=45）和0．6μg/ml舒芬太尼混合罗哌卡因组（B组）（n=55）。2组均在宫口扩张至2—3cm时行硬膜外穿刺，置管。2组第1例产妇罗哌卡因浓度均为0．12％，随后的罗哌卡因浓度按序贯法确定：即前1例若镇痛有效（注药后30min时VAS评分≤3分），则下1例接受的药物降低一个浓度梯度，若镇痛无效，则上升一个浓度梯度，浓度梯度0．01％。若镇痛效果可疑，则下1例接受的药物维持原浓度，计算罗哌卡因的EC50及其95％可信区间。观察镇痛期间发生的不良反应。结果 A组、B组皮肤瘙痒发生率分别为11．9％、29．4％（P〈0．05），A组、B组各有1例发生恶心呕吐（P〉0．05）。A组罗哌卡因的EC50为0．059％（95％可信区间为0．056％-0．062％），B组罗哌卡因的EC50为0．054％（95％可信区间为0．053％-0．055％）。结论硬膜外混合0．4、0．6μg/ml舒芬太尼分娩镇痛时，罗哌卡因的E‰分别为0．059％、0．054％；舒芬太尼的推荐浓度为0．4μg/ml。
Objective To determine the median effective concentration （EC50） of ropivacaine when combined with different concentrations of sufentanil for epidural labor analgesia. Methods One hundred ASA Ⅰ or Ⅱ nulliparous parturients at 37-42 weeks of gestation with 2-3 cm cervical dilation, requesting epidural analgesia were randomly assigned into 2 groups： group A （n = 45） received 0.4 tμg·ml^-1 sufentanil ＋ ropivacaine and group B （ n = 55） received 0.6 μg· ml^-1 sufentanil ＋ ropivacaine. The EC50 of ropivacaine was determined by up-and-down sequential test. The initial concentration of ropivacaine was set at 0.12% . The concentration of ropivacaine was increased or decreased with increment of 0.01% . If effective, the next parturient received ropivacaine at a lower concentration; if ineffective at a higher concentration. VAS （0-10, 0 = no pain, 10 = worst pain） was used to assess the analgesia. If the VAS score was ≤3 within 30 min after ropivacaine administration, analgesia was defined as effective. The up-and-down sequences were analyzed by using Dixon method to determine the EC50 and 95 % confidence interval （CI）. The side effects were also recorded. Results The EC50 of epidural ropivacaine was 0.059% in group A （95% CI, 0.056%-0.062%） and 0.054% in group B （95% CI, 0.053%-0.055% ）. The incidence of pruritus was 11.9% in group A and 29.4% in group B respectively（ P 〈 0.05）. One patient in each group had PONV.Conclnsion The ECs0 of ropivacaine was 0.059% when combined with 0.4μg·ml^-1 sufentanil and was 0.054% when combined with 0.6μg·ml^-1 sufentanil for epidural labor analgesia. It is suggested that 0.4μg·ml^-1 sufentanil is the suitable concentration for epidural labor analgesia when combined with ropivacaine.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2007年第1期14-16,共3页
Chinese Journal of Anesthesiology
关键词
酰胺类
舒芬太尼
镇痛
硬膜外
产科
剂量效应关系
药物
Amides
Sufentanil
Analgesia, epidural
Analgesia, obstetrical
Dose-response relationship, drug
