文章摘要
罗哌卡因复合氢吗啡酮用于分娩镇痛的半数有效间隔时间
Median effective interval of ropivacaine combined with hydromorphone for labor analgesia
  
DOI：10.12089/jca.2024.11.006
中文关键词: 分娩镇痛  程控硬膜外间歇脉冲注入  氢吗啡酮  半数有效间隔时间
英文关键词: Labour analgesia  Programmed intermittent epidural bolus  Hydromorphone  Median effective interval
基金项目:
作者单位E-mail
陈旭林 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科  
徐世琴 210004,南京医科大学附属妇产医院（南京市妇幼保健院）麻醉科 xusqnj@126.com 
摘要点击次数: 294
全文下载次数: 50
中文摘要:
      
目的： 探讨程控硬膜外间歇脉冲注入（PIEB）技术在罗哌卡因复合氢吗啡酮用于分娩镇痛中的有效间隔时间。
方法： 选择单胎头位初产妇101例，年龄20～40岁，BMI 20～35 kg/m2， ASA Ⅰ或Ⅱ级，孕期37～42周。采用随机数字表法将产妇分为五组：PIEB间隔时间40 min组（P40组，n=20）、PIEB间隔时间50 min组（P50组，n=19）、PIEB间隔时间60 min组（P60组，n=20）、PIEB间隔时间70 min组（P70组，n=20）和PIEB间隔时间80 min组（P80组，n=22）。给予负荷剂量12 ml 1 h后采用PIEB模式行硬膜外分娩镇痛，间隔时间根据各组分配时间确定，泵内药物为0.1%罗哌卡因复合氢吗啡酮15 μg/ml共12 ml。根据有效镇痛率（第一产程结束前无需追加镇痛药物的产妇比例），采用Probit回归法计算半数有效间隔时间（EI50）和90%有效间隔时间（EI90）。记录镇痛前、镇痛后20 min、1、2、3、4 h、宫口开全时的VAS疼痛评分。记录分娩镇痛中最高感觉阻滞平面、运动阻滞情况（改良Bromage评分）。记录产妇不良反应发生情况和新生儿体重、出生后1、5 min Apgar评分。
结果： P40组、P50组、P60组、P70组和P80组有效镇痛率分别为95.0%、84.2%、70.0%、55.0%和50.0%，采用Probit回归法计算，EI50和EI90分别为76.5 min（95%CI 69.0～93.9 min）和43.4 min（95%CI 17.6～52.7 min）。两组不同时点VAS疼痛评分、最高感觉阻滞平面、改良Bromage评分、产妇不良反应发生率和新生儿情况差异无统计学意义。
结论： 采用0.1%罗哌卡因复合氢吗啡酮15 μg/ml PIEB行分娩镇痛的EI50和EI90分别为76.5 min（95%CI 69.0～93.9 min）和43.4 min（95%CI 17.6～52.7 min）。
英文摘要:
      
Objective: To investigate the effective interval of programmed intermittent epidural bolus (PIEB) in labor analgesia with ropivacaine and hydromorphone.
Methods: A total of 101 puerpera with singleton pregnancy, head position, aged 20-40 years, BMI 20-35 kg/m2, ASA physical status Ⅰ or Ⅱ, gestational age 37-42 weeks, were randomly allocated into five different PIEB intervals groups: PIEB 40 minutes group (group P40, n = 20), PIEB 50 minutes group (group P50, n = 19), PIEB 60 minutes group (group P60, n = 20), PIEB 70 minutes group (group P70, n = 20), and PIEB 80 minutes group (group P80, n = 22). The PIEB dose was fixed at 10 ml with the first bolus given 1 hour after the initial manual loading dose with subsequent boluses continued at intervals according to different group allocation. Analgesia was provided using PIEB with 0.1% ropivacaine combined with hydromorphone 15 μg/ml for a total of 12 ml. Based on effective analgesia rate (proportion of women who do not require additional analgesic drugs by the end of the first stage of labor). Probit regression was used to estimate median effective interval (EI50) and 90% effective interval (EI90). VAS pain scores before analgesia, 20 minutes, 1 hour, 2, 3, and 4 hours, at full opening of the cervix were recorded. The highest level of sensory blockade and motor blockade (modified Bromage score) were recorded, maternal adverse effects were recorded. Neonatal weight, 1 minute and 5 minutes postnatal Apgar scores were recorded.
Results: Effective analgesia rates were 95.0%, 84.2%, 70.0%, 55.0%, and 50.0% in groups P40, P50, P60, P70, and P80, respectively. The EI50 and EI90 were 76.5 minutes (95% CI 69.0-93.9 minutes) and 43.4 minutes (95% CI 17.6-52.7 minutes) analysing by Probit regression. There were no significant differences in VAS pain score at different time, maximum sensory block plane, modified Bromage score, incidence of maternal adverse reactions and neonatal conditions between the two groups.
Conclusion: The EI50 and EI90 of PIEB 0.1% ropivacaine combined with hydromorphone 15 μg/ml for labor analgesia were 76.5 minutes (95% CI 69.0-93.9 minutes) and 43.4 minutes (95% CI 17.6-52.7 minutes), respectively.
查看全文   查看/发表评论  下载PDF阅读器
关闭