摘要
目的 通过与腰麻-硬膜外联合麻醉(CSEA)后病人自控硬膜外镇痛法(PCEA)进行比较,观察曲马多病人自控静脉镇痛法(PCIA)用于分娩镇痛的效果及其对分娩过程和胎儿的影响。方法 选择单胎足月初产妇80例,随机分为3组。对照组(n=30)按产科常规处理,未行分娩镇痛。A组(n=30):蛛网膜下腔注射罗哌卡因2.5mg+芬太尼5μg,然后连接硬膜外镇痛泵,PCEA输注0.1％罗哌卡因与芬太尼1.5μg/ml,单次剂量4ml,锁定时间15min,背景剂量4ml/h;B组(n=20):先静脉注射1mg/kg负荷量的曲马多,然后连接静脉镇痛泵,PCIA输注0.75％曲马多,单次剂量2 ml,锁定时间10min,背景剂量2 ml/h,总剂量不超过500 mg。连续监测呼吸循环情况,采用视觉模拟疼痛评分(VAS)评估镇痛效应,运动阻滞程度按改良的Bromage标准进行测定,观察记录产程进展、宫缩及胎心情况、新生儿情况及不良反应。结果 第一产程中A、B组的VAS评分分别为33±13、47±23,与对照组比较,显著减低(P<0.01),A、B组间也有显著性差异(P<0.05);第二产程A、B组的VAS评分分别为39±22、51±27,与对照组比较,仍显著减低(P<0.01),但A、B组间无显著性差异。A组的镇痛起效时间(2.4±1.2)min快于B组(5.3±2.7)min(P<0.05)。B组新生儿各时点Apgar评分均低于A组(P<0.05)。A组的第二产程(67±51)
Objective To evaluate the analgesic efficacy and safety of patient controlled intravenous analgesia (PCIA) with tramadol for labor analgesia as compared with combined spinal-epidural analgesia (CSEA) + patient controlled analgesia (PCEA) with ropivacaine and fentanyl. Methods Eighty ASA Ⅰ - Ⅱ full term primigravidae in active labor (at 2 ～ cm cervical dilation) who had a single fetus with vertex presentation and were expected to have a vaginal delivery were randomly divided into 3 groups: 1 control group received no analgesia ( n = 30), Ⅱ group A received CSEA + PCEA with ropivacaine and fentanyl ( n = 30) and Ⅲ group B received PCIA with tramadol (n = 20) . In group A CSEA was performed at L2-3. Ropivacaine 2.5 mg and fentanyl 5 mg were injected intrathecally. A catheter was then advanced 4 cm into epidural space cephalad for PCEA with a mixture of 0.1% ropivacaine with fentanyl 5μg·ml-1 (background infusion 4 ml·h-1 , demand bolus 4 ml with a 15 min lockout interval). In group B the loading dose of tramadol was 1 mg·kg-1 followed by background infusion of 0.75% tramadol at a rate of 2 ml·h-1 (demand bolus 2 ml with a 10 min lockout interval and a total dose limit of 500 mg) . The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified Bromage score. The vital signs (BP, HR, SpO2), fetal heart rate, labor process, mode of delivery, Apgar score of neonates and side effects of analgesia were recorded. Results Good analgesia was achieved with high patient satisfaction in group A (96.7%) and B (95%) as compared with control group, but there was no significant difference in VAS score between group A and B. The onset time of analgesia was significantly shorter in group A (2.4 ± 1.2) min than that in group B (5.3 ± 2.7) min ( P < 0.05). Apgar score was higher in group A and control group than that in group B (P < 0.05). The duration of second stage of labor was longer in group A (67 ±51) min than that in group B (41±20) min and control group (44 ± 21) min ( P < 0.05) . The rate of cesarean section was significantly higher in control group (16.7% ) than that in group A (3.3% ) and B (5.0% ), but the difference between group A and B was not statistically significant. There was no significant difference in vital signs, fetal heart rate, degree of motor block and uterine contraction among the 3 groups. Conclusion CSEA + PCEA with ropivacaine and fentanyl is safe and effective for labor analgesia and is the technique of choice. PCIA with tramadol is a useful alternative if the parturient refuses or is not indicated for combined spinal-epidural analgesia, but the analgesia is less satisfactory and the potential fetus depression is a problem.
出处
《中华麻醉学杂志》
CAS
CSCD
北大核心
2003年第2期91-94,共4页
Chinese Journal of Anesthesiology
