鞘内注射小剂量舒芬太尼对罗哌卡因硬膜外分娩镇痛ec50的影响.doc

鞘内小剂量舒芬太尼罗哌卡因硬膜外分娩镇痛 肖飞1 陈新忠 2徐文平1ntrathecal low-dose sufentanil lowers the EC50 of epidural ropivacaine for labor analgesia Xiao F1, Chen XZ 2, Xu WP1 (1嘉兴市妇幼保健院2通讯作者，浙江大学医学院附属妇产科医院) 【摘要】目的 评价鞘内注射5μg舒芬太尼对硬膜外分娩镇痛罗哌卡因EC50）的影响。方法 选择初产妇60例，随机分为硬膜外组和腰硬联合组（n=30），两组产妇于L23间隙行硬膜外穿刺并向头侧置管4厘米，腰硬联合组鞘内注射5μg的舒芬太尼0.4μg ml-1舒芬太尼罗哌卡因第一例罗哌卡因浓度为0.12%，罗哌卡因浓度计算出两组罗哌卡因的EC50。采用视觉模拟评分法（VAS）评价注药产程中疼痛程度，观察产妇麻醉平面、运动阻滞、不良反应及满意度，观察胎心率、新生儿Apgar评分。结果 硬膜外组罗哌卡因的EC50为0.0，95％CI(0.04~0.061%)；腰硬联合组EC50为0.0，95％CI(0.02~0.041%)，差异有统计学意义（P＜0.05）。与硬膜外组比较腰硬联合组镇痛后5min的VAS评分明显降低（P＜0.05），瘙痒的发生率明显增高（P＜0.05），镇痛的满意程度高（P＜0.05）。结论 鞘内注射5μg的舒芬太尼可以明显降低硬膜外罗哌卡因分娩镇痛的EC50。 【关键词】鞘内 舒芬太尼 罗哌卡因 硬膜外 分娩镇痛 【Abstract】 Objective To evaluate the effect of intrathecal sufentanil 5μg the 50% effective concentration (EC50) of epidural ropivacaine for labor analgesia. Methods Sixty nulliparous women were randomly assigned to one of two groups ( n=30 each ): Combined spinal and epidural anesthesia(CSEA) group and epidural anesthesia (EA) group. In addition to that the patients in CSEA group were received 5μg sufentanil intrathecally, all patients in both groups were inserted with an epidural catheter at L2,3 interspace and 4cm cephalad in the epidural space. Each patient received a bolus of 10 ml ropivacaine combined with 0.4μg ml-1 sufentanil. The ropivacaine concentration was 0.12% for the first case in both group. The ropivacaine concentration for the consequent cases were increased or decreased by 0.01% according to up-down sequential method. The Dixon up-down method was used to determine EC50 .Visual analog Score (VAS) for pain, level of sensory blockade, modified Bromage score, the adverse effects and patient satisfaction were recorded. The fetal heart rate and neonatal Apgar scores were monitored. Results The EC50 of epidural ropivacaine for labor analgesia was significantly higher in EA group [0.063% (95% CI, 0.041%~0.081%)] than that in CSEA group [0.044%(95% CI, 0.029%~0.057%)].Compared with group EA, VAS of five m