摘要
目的研究罗哌卡因复合舒芬太尼硬膜外分娩镇痛对胎心率(FHR)的影响。方法足月产妇132例,随机均分为四组,硬膜外负荷量分别为0.1%罗哌卡因10ml(S0组),0.1%罗哌卡因10ml复合舒芬太尼5μg(S1组)、10μg(S2组)、15μg(S3组);维持剂量均为0.1%罗哌卡因持续背景输注10ml/h,每15分钟追加3ml。记录镇痛前后90min的FHR,FHR加速的数量,早期、变异、迟发FHR减速的数量和持续时间,小振幅FHR变异持续总时间。结果四组产妇分娩过程中硬膜外注药后均未发生心率变化和呼吸抑制情况,对镇痛效果均表示满意。S2组和S3组各有1例产妇在镇痛后出现短暂低血压,输注复方乳酸钠纠正。低血压时S2组出现短于60s的胎心变异减速,S3组出现长于60s的胎心变异减速。四组镇痛后0～30、30～60min时间段单个胎心减速平均值、胎心减速持续总时间较镇痛前30～0min明显延长(P<0.01),且S3组单个胎心减速时间明显长于其它三组(P<0.01)。S3组有2例各出现1次与血压无关且长于60s的变异减速,S3组有3例出现长于60s的变异减速。结论 0.1%罗哌卡因10ml复合5或10μg舒芬太尼作为硬膜外镇痛负荷量对FHR改变是可逆的。
Objective To investigate the effects of epidural analgesia with ropivacaine combined with sufentanil on fetal heart rate（FHR）during labor.Methods A total of 132 parturients were randomly divided into four groups（n=33 each） according to epidural loading dose.Group S0：10 ml 0.1% ropivacaine;group S1：10 ml 0.1% ropivacaine with 5 μg sufentanil;group S2：10 m 0.1% ropivacaine with 10 μg sufentanil;group S3：10 ml 0.1% ropivacaine with 15 μg sufentanil.Maintenance of analgesia was achieved with a continuous infusion rate of 10 ml/h ropivacaine 0.1% with a 3 ml bolus dose within 15 min.FHR traces 90 minutes before and after the beginning of epidural analgesia,baseline FHR,number of FHR accelerations,number and total duration of early,variable,and late FHR decelerations,and duration of small amplitude FHR variability were recorded.Results The mean durations of single FHR deceleration in four groups during 0-30,30-60 min segment after analgesia were longer than that during 30-0 min segment before analgesia,furthermore the average single FHR deceleration during 0-30 min in group S3 was longer than that in group S0,S1 and S2（P〈0.01）.Total duration of FHR decelerations in four groups during 0-30,30-60 min segment after analgesia were longer than that during 30-0 min segment before analgesia（P〈0.01）.The times of FHR acceleration in four groups during 0-30 min segment after analgesia were fewer than those during 30-0 min segment before analgesia（P〈0.01）.The duration of FHR small amplitude long-term variability of four groups during 0-30 min segment after analgesia were longer than that during 0-30 min segment before analgesia（P〈0.01）.Conclusion Epidural loading with 10 ml 0.1% ropivacaine and 5 μg or 10 μg sufentanil during labor analgesia has a reversible effect on FHR.
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2012年第4期337-339,共3页
Journal of Clinical Anesthesiology
关键词
罗哌卡因
舒芬太尼
硬膜外镇痛
胎心率
Ropivacaine； Sufentanil； Epidural analgesia； Fetal heart rate
