肾上腺素用于左旋布比卡因复合舒芬太尼硬膜外分娩镇痛的临床研究被引量：1

Effects of epinephrine on efficacy of levobupivacaine-sufentanil during epidural labor analgesia

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摘要目的：验证肾上腺素对于左旋布比卡因复合舒芬太尼（LS）用于硬膜外分娩镇痛的镇痛强度、药物用量及并发症发生率的影响．方法：产科ASAI～Ⅱ级，妊娠36～42wk，要求分娩镇痛的产妇共70例，随机等分为左旋布比卡因复合舒芬太尼及肾上腺（LSE）组和LS组，等产程进入活跃期，宫口开至2～3em时，开始进行分娩镇痛．硬膜外穿刺成功后，LSE组产妇给予1．25g／L左旋布比卡因和0．75mg／L舒芬太尼以及1．25mg／L（1：800000）肾上腺素混合溶液10mL，LS组则给予1．25g／L左旋布比卡因和0．75mg／L舒芬太尼混合液10mL．给予首量20min后开始产妇自控镇痛．记录产妇所需镇痛药物的总量和每小时产妇所需要的药物量．同时统计各产妇给予首量至分娩结束的时间，分娩的方法，以及并发症的发生率．通过VAS评分和Bromage评分评估产妇疼痛和下肢运动阻滞情况．结果：LSE组产妇的每小时药物需要量小于LS组，给予首量后15，20min，LSE组产妇的VAS评分明显低于LS组．两组产妇从给予首量至分娩结束的时间无统计学差异，而LSE组的第二产程时间长于LS组．LSE组产妇Bromage评分≥1分者多于LS组，而其它并发症，如恶心、呕吐、瘙痒、寒战的发生率无统计学差异．结论：小剂量的肾上腺素用于Ls硬膜外分娩镇痛可以增强其镇痛作用，加快镇痛药物的起效时间，但同时也增加了运动阻滞的程度，有可能导致第二产程延长． AIM： To investigate whether epinephrine increases the efficacy of levobupivacaine and sufentanil during epidural la- bor analgesia. METHODS： Seventy ASA Ⅰ- Ⅱ nulliparous women of 37 -42 weeks gestation, with 2 -3 cm cervical dilatation were randomly assigned to two groups： LSE group and LS group. All patients received an epidural injection of levobupiva- caine 1. 25 g/L and sufentanil 0. 75 mg/L with or without 1：800 000 epinephrine. After an initial dose of 10 mL, a patient- controlled analgesia pump started. Total and hourly drug con- sumption, pain scores, motor block, duration of labor, vital va- riables, and side effects were compared between two groups by using the visual analog scale and Bromage scale. RESULTS： Hourly drug consumption and pain scores at 15 min and 20 min were lower in LSE group than in LS group. The incidence of motor block and duration of the second stage of labor tended to be higher in LSE group than in LS group. There were more patients with Bromage score ≥ 1 in LSE group than in LS group. There was no significant difference in occurrence of other complications, such as nausea, vomitting, pruritus, and chill, etc. CONCLUSION： Epinephrine intensifies the effects of epidural levobupivacaine and sufentanil, but may aggratate motor block and increase the second labor stage.

作者刘丽萍黄安宁陈娜米卫东

机构地区解放军总医院麻醉手术中心武警北京总队医院麻醉科

出处《第四军医大学学报》北大核心 2007年第21期2004-2007,共4页 Journal of the Fourth Military Medical University

关键词肾上腺素布比卡因舒芬太尼镇痛产科 epinephrine Bupivacaine supentanil obstetricalanalgesia

分类号 R614.42 [医药卫生—麻醉学]

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