布比卡因复合新斯的明应用于分娩镇痛的疗效

Efficacy of epidural neostigmine coadministered with bupivacaine for labor analgesia

目的比较不同剂量布比卡因复合新斯的明对硬膜外分娩镇痛的疗效。方法将100例初产妇随机均分成4组,分别在硬膜外腔注入布比卡因20mg(组Ⅰ)、布比卡因20mg+新斯的明1μg/kg(组Ⅱ)、布比卡因20mg+新斯的明2μg/kg(组Ⅲ)和布比卡因20mg+新斯的明4μg/kg(组Ⅳ)。比较自注药开始至胎儿娩出时布比卡因的总用量、镇痛效果以及下肢运动阻滞和不良反应发生率。结果4组间的一般资料、镇痛效果及产程的差异均无统计学意义(P值均＞0．05),组Ⅰ的布比卡因总用量为(74．2±10．9)mg,明显高于其他3组(P值均＜0．01);组Ⅰ下肢运动阻滞发生率为32%,明显高于组Ⅱ(8%)、组Ⅲ(4%)和组Ⅳ(4%,P值均＜0．05)。4组间不良反应发生率的差异均无统计学意义(P值均＞0．05)。结论硬膜外布比卡因复合新斯的明(1μg/kg)可提高分娩镇痛的疗效,可安全应用于临床分娩镇痛。

Objective To compare the efficacy of different doses of epidural neostigmine coadministered with bupivacaine for labor parturients. Methods One hundred parturients were randomly allocated into one of the following four groups： bupivacaine 20 mg （group Ⅰ ）, bupivacaine 20 mg＋ neostigmine 1 μg/kg（group Ⅱ ）, bupivacaine 20 mg＋neostigmine 2 μg/kg（group Ⅲ ）, and bupivacaine 20 mg＋ neostigmine 4 μg/kg（group Ⅳ ）. At the end of labor, the total doses of bupivacaine, analgesic effect, and blockage of lower limbs motion and other adverse effects were compared among the four groups. Results There was no difference in the demographic data and analgesic effects among the four groups. The total dose of bupivacaine in group Ⅰ was （74.2 ± 10.9） mg, significantly higher than those in group Ⅱ , Ⅲ and Ⅳ （all P 〈 0.05）. The blockage of limbs motion in group Ⅰ was 8/25, also higher than those in group Ⅱ, Ⅲ and Ⅳ （all P 〈 0.05）. No difference in the adverse effects was observed among them. Conclusions Epidural neostigmine coadministered with bupivacaine enhances the analgesic effect for parturients and is safe for labor analgesia. （Shanghai Med J, 2007, 30：419=421）