摘要
目的观察不同浓度氢吗啡酮对罗哌卡因硬膜外阻滞分娩镇痛效应的影响。方法选择单胎足月临产妇80例,ASAⅠ或Ⅱ级,均进入第一产程活跃期,随机分为4组。均行罗哌卡因硬膜外镇痛,H0组单纯给予罗哌卡因,H1、H2、H3组分别给予罗哌卡因混合5、10、15μg·mL^-1氢吗啡酮,药液量均为15 mL,给药速度10mL·min^-1。罗哌卡因浓度采用序贯法确定,每组初始浓度为0.1%。记录给药前和给药后5、15、30 min各组产妇平均动脉压、心率、脉搏氧饱和度等,以疼痛视觉模拟量表(VAS)评估镇痛效果,并观察不良反应发生情况。使用概率单位回归分析计算氢吗啡酮的半数有效浓度(EC50)。结果共有77例完成试验,H0、H1、H2、H3组分别完成20例、16例、18例、23例。各组给药后VAS评分均显著下降(P<0.05),镇痛起效时间和各观察时点VAS评分无显著差异(P>0.05)。各组硬膜外罗哌卡因分娩镇痛的EC50及其95%可信区间(95%CI)为:H0组0.083%(95%CI:0.073%~0.091%),H1组0.070%(95%CI:0.062%~0.077%),H2组0.066%(95%CI:0.058%~0.072%),H3组0.058%(95%CI:0.051%~0.064%),H1、H2、H3组EC50均低于H0组(P<0.05),H1、H2、H3各组间比较无显著差异(P>0.05)。各组产程时间、胎儿心率、新生儿Apgar评分等比较差异均无显著意义(P>0.05),均无严重不良反应发生。结论氢吗啡酮复合罗哌卡因可安全有效用于硬膜外分娩镇痛,氢吗啡酮推荐浓度为5μg·mL-1。
AIM To observe the effects of different concentrations of hydromorphone on epidural ropivacaine analgesia in labor.METHODS Eighty single full-term parturient women,ASAⅠorⅡ,entered the active stage of the first stage of labor were enrolled and divided into four groups.All parturient women received epidural puncture,and ropivacaine or ropivacaine-hydro morphone mixture was administered at rate of10 mL·min^-1.The parturient women were given ropivacaine alone in the H0 group,and ropivacaine mixed with5,10,15μg·mL^-1 hydro morphone in the H1,H2,H3 group.The first patient in each group received 0.1%ropivacaine,then the next case was determined by sequential method.The mean arterial pressure,heart rate,pulse oxygen saturation,and so on were recorded before and 5,15 and 30 minutes after administration.The analgesic effect was evaluated by pain visual analogue scale(VAS)and the occurrence of adverse reactions was observed.The half effective dose(EC50)of ropivacaine in each group was calculated by probability unit regression analysis.RESULTS A total of 77 cases completed the test,and 20,16,18,23 cases in H0,H1,H2,H3 group respectively.Compared with those before administration,the VAS scores decreased significantly in four groups(P<0.05).But there were no significant differences in analgesia onset time and VAS score at each point among groups(P>0.05).The EC50 and 95%confidence interval(95%CI)of epidural ropivacaine for labor analgesia in the H0,H1,H2,H3 group were 0.083%(95%CI:0.073%to 0.091%),0.070%(95%CI:0.062%to 0.077%),0.066%(95%CI:0.058%to 0.072%),0.058%(95%CI:0.051%to0.064%).The EC50 in the H1,H2,H3 group were lower than that in the H0 group(P<0.05),and there was no significant difference among H1,H2 and H3 group(P>0.05).There were no significant differences in duration of labor,fetal heart rate,Apgar score among the four groups(P>0.05).No serious adverse reactions occurred.CONCLUSION Hydromorphone combined with ropivacaine can be effectively and safely used for epidural labor analgesia.The recommended concentration of hydromorphone is 5μg·mL-1.
作者
罗妙妙
陈新忠
祝胜美
LUO Miao-miao;CHEN Xin-zhong;ZHU Sheng-mei(The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou ZHEJIANG 310003,China;Zhejiang Hospital,Hangzhou ZHEJIANG 310030,China;Hospital of Obstetrics and Gynecology Affiliated to Medical College of Zhejiang University,Hangzhou ZHEJIANG 310006,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2019年第12期734-738,共5页
Chinese Journal of New Drugs and Clinical Remedies
作者简介
罗妙妙,女,主治医师,硕士在读,主要从事围术期快速康复的研究,Phn:86-571-8798-7373,E-mail:mmluo1022@163.com。
