摘要
目的采用序贯法分析剖宫产病人腰-硬联合麻醉中联合应用芬太尼对罗哌卡因半数有效剂量(ED50)的影响。方法选择大邑县人民医院择期拟行剖宫产术的足月单胎初产妇100例作为研究对象,采用抽签法法将产妇随机分为0.5%罗哌卡因组(R组,n=50)和0.5%罗哌卡因联合10μg芬太尼组(RF组,n=50)。R组和RF组0.5%罗哌卡因的初始剂量分别为15 mg和8 mg,根据阻滞效果按照Dixon序贯法确定下一例产妇的剂量,剂量调整间隔为0.5 mg。采用Probit概率单位回归法计算两组产妇ED50及其95%置信区间(95%CI)。结果 RF组ED50为6.370 mg(95%CI:5.892~11.477 mg),R组ED50为14.088 mg(95%CI:13.412~20.893 mg),与R组比较,RF组产妇的0.5%罗哌卡因半数有效剂量更低,感觉阻滞起效早,运动阻滞程度低,差异有统计学意义(P<0.05)。结论剖宫产患者腰-硬联合麻醉中联合应用芬太尼可以有效降低罗哌卡因半数有效剂量(ED50),可以保证满意的麻醉效果前提下减少罗哌卡因的用药,缩短麻醉的起效时间,降低麻醉并发症的发生风险,值得在临床推广应用。
Objective To explore the effect of adding 10μg fentanyl on 50% effective dose of ropivacaine during spinal-epi- dural anesthesia in cesarean section.Methods One hundred cases of full term primiparas undergoing selective cesarean section under combined spinal-epidural anesthesia in our hospital were selected as research subjects.The parturients were randomly divided into ropi-vacaine group （group R,n= 50 ） and ropivacaine combined fentanyl group （group R,n= 50 ） . The initial doses were 15 mg for the R group,and 8 mg for the RF group.The dose was increased or decreased by0.5 mg in next parturient using an up-and-down sequential allocation technique.The ED50 and 95% confidence interval （Cl） were calculated by Probit Regression Model.Results The ED50 of0.5% ropivacaine used for caesarean section was 14.088 mg （95CI ： 13.412 - 20.893 mg） while with fentanyl, ED50 was 6.370 mg （95CI ： 5.892 - 11.477 mg） .The ED50 of0.5% ropivacaine in the RF group was significantly lower than that of the R group （ P〈0.05 ）.The onset time of sensory block in the R group was significantly later than that of the RF group （P〈0.05 ） while the degree of motor block in the R group was more than that of the RF group （ P〈0.05 ） .Conclusion The combined use of fentanyl with ropivacaine in caesarean section can effectively reduce the 50% effective dose.It can reduce the use of ropivacaine on the premise of satisfactory anesthesia, shorten the onset time of anesthesia and reduce the risk of complications.It is worthy of clinical application.
作者
欧玉清
OU Yu-qing(Department of Anesthesiology,Dayi County Peopled Hospital,Chengdu 611330,China)
出处
《实用医院临床杂志》
2018年第5期220-222,共3页
Practical Journal of Clinical Medicine
关键词
腰-硬联合麻醉
芬太尼
罗哌卡因
剂量效应关系
剖宫产术
Spinal-epidural anesthesia
Fentanyl
Ropivacaine
Dose-response relationship
Cesarean section
