摘要
目的 探讨氢吗啡酮复合罗哌卡因行硬膜外分娩镇痛时氢吗啡酮的半数有效剂量（ED50）和罗哌卡因的适宜有效浓度.方法 选择2016年1至6月接受分娩镇痛的初产妇140例,前50例患者中第1个患者接受0.12%罗哌卡因＋20 μg/ml氢吗啡酮复合液,随后的产妇运用改良序贯法确定氢吗啡酮的ED50、95%有效剂量（ED95）.另90例患者按照随机数字表法平均分为H1组、H2组、H3组,分别给予0.08%罗哌卡因＋15 μg/ml氢吗啡酮（H1组）、0.10%罗哌卡因＋15 μg/ml氢吗啡酮（H2组）及0.12%罗哌卡因＋15 μg/ml氢吗啡酮（H3组）.监测分娩镇痛过程中阻滞平面和运动阻滞（Bromage评分）、镇痛评分及宫缩胎心;记录麻醉起效时间、产程时间、分娩方式、缩宫素使用增加例数及新生儿Apgar评分,记录恶心、呕吐、瘙痒、胎心减速等不良反应发生率.结果 氢吗啡酮的ED50值及ED95值分别为10.49 μg/ml（95% CI：8.89~11.79）和15.15 μg/ml（95% CI：13.25 -22.25）.H1组起效时间为（14.23 ±3.82）min,明显长于H2组的（11.32 ±2.16）min 及H3组的（10.83 ±2.56）min,差异有统计学意义（t=5.854、6.212,均P〈0.05）,H1组镇痛后30、60和90 min时的视觉模拟评分（VAS）明显高于H2、H3组（均P〈0.05）,H1组停药时的VAS评分为（3.25 ± 0.75）分,明显高于H3组（0.27 ±0.12）分,差异有统计学意义（t=9.314,P〈0.05）.H1组在镇痛后第4、5、6次宫缩时的VAS评分明显高于H2、H3组（均P〈0.05）.H3组运动神经阻滞发生率为26.67%,明显高于H1、H2组的6.66%、3.33%,差异有统计学意义（χ^2=6.413、4.320,均P〈0.05）.结论 0.10%罗哌卡因复合15 μg/ml氢吗啡酮行分娩镇痛时镇痛效果好、无运动阻滞、安全性高,值得临床推广.
Objective To investigate the median effective dose （ED50） of hydromorphone and the appropriate concentration of ropivacaine combined with hydromorphone in epidural labor analgesia. Methods One hundred and forty nulliparous women undergoing labor selected for delivery with epidural analgesia were enrolled in our hospital from January to June 2016. The first of top 50 women received 0. 12% ropivaeaine plus 20 μg/ml hydromorphone complex solution, then sequential women were used the modified sequential method to determine the EDs0 and ED95 of h＇ydromorphone. The other 90 women were randomly divided and receieved 0.08% ropivacaine and 15 μg/ml hydromorphone（ H1 group）, 0. 10% ropivacaine and 15 μg/ml hydromorphone （H2 group）, 0. 12% ropivacaine and 15 μg/ml hydromorphone （group H3 ） respectively for cpidural labor analgesia. In the course of labor, block levels of epidural analgesia, the Bromage scores, analgesia scores and fetal heart rate-uterine coneraction were monitored. In addition, onset time of anesthesia, labor time, mode of delivery, cases of increased oxytoein using, neonatal Apgar score, incidence of nausea and vomiting, itching and fetal heart reduction were recorded. Results The EDs0 and ED95 values of hydromorphone were 10.49 （95% CI：8.89 - 11.79） and 15.15 （95% CI： 13.25 - 22.25） μg/ml respectively. The onset time in group H1 was significantly longer than those in group H2 and H3 （ （ 14. 23±3.82） , （ 11.32 ± 2. 16 ）, （ 10. 83 ± 2. 56 ） rain, respectively） , the difference was statistically significant （t =5. 854, 6. 212, all P 〈0. 05）. Analgesic VAS score at 30, 60 and 90 rain time points in H1 group was significantly higher than that in H2 group and H3 group （ all P 〈 0. 05 ）. VAS score at withdrawal in H1 group was significantly higher than that in group H3 （ （3.25 ±0. 75） vs （0. 27 ±0. 12） ）, the difference was statistically significant （ t = 9.314, P 〈 0.05 ）. VAS scores at the fourth, fifth, sixth contractions a
出处
《中华医学杂志》
CAS
CSCD
北大核心
2017年第42期3297-3300,共4页
National Medical Journal of China
基金
温州市科技局项目（Y20160391）
关键词
氢吗啡酮
罗哌卡因
分娩镇痛
Hydromorphone
Ropivacaine
Labor analgesia
