罗哌卡因复合舒芬太尼用于无痛分娩最佳有效浓度探讨

EFFECTIVE CONCENTRATION OF ROPIVACAINE PLUS COMPOUND SUFENTANIL FOR DELIVERY

目的:通过序贯法测定分娩镇痛时硬膜外腔使用舒芬太尼与之配伍的罗哌卡因的最低半数有效浓度(EC50),分析其对分娩过程的影响,找出其最佳有效用药浓度。方法:取320例ASAⅠ~Ⅱ级单胎头位的初产妇,妊娠≥38周,产前无服用镇痛催眠药史及产科并发症等。随机分为2组,A组:罗哌卡因+0.4μg/mL舒芬太尼;B组:罗哌卡因+0.6μg/mL舒芬太尼。宫口开至3~4 cm时于L2~3间隙硬膜外穿刺置管,分别注入15mL不同浓度的舒芬太尼和罗哌卡因混合液。根据双盲、序贯方法,以上一例产妇的用药浓度,确定下一例用药浓度,两组罗哌卡因起始浓度为0.12%。视觉模拟评分(VAS)≤3分为有效。结果:A、B组罗哌卡因EC50分别为0.62%和0.048%,两组罗哌卡因浓度分别在0.08%~0.1%和0.07%~0.1%,VAS评分全部≤3分,且无运动神经阻滞,不良反应B组较多。结论:以舒芬太尼0.4μg/mL、罗哌卡因浓度0.08%~0.1%为佳。

OBJECTIVE:To determine the optimum concentration of ropivacaine plus compound sufentanil for epidural anesthesia in child delivery.METHOD:320 primipara with ASA grade I-II and single birth and head position were divided into two groups at random: Group A was given ropivacaine 0.4ug/ml plus sufentanil;Group B was given ropivacaine 0.6ug/ml plus sufentanil.When cervix opened to 3~4cm,mixed liquid 15 ml of ropivacaine and sufentanil was injected epidurally for analgesia.According to sequential and double-blind principle,the concentration of drug was decided by the dosage of the prior primipara with the starting concentration of 0.12%.The visual analog scale(VAS) ≤3 was effective.RESULTS: The EC50 of ropivacaine in Group A and B was 0.62% and 0.048%.Concentration of ropivacaine arranged in 0.08%~0.1% and 0.07%~0.1% in the two groups respectively.VAS ≤3 scores and there was no nerve block.There were more untoward reactions in group B.CONCLUSION:The optimum concentration of sufentanil is 0.4%ug/ml and of ropivacaine is 0.08%~0.1% for anesthesia in delivery.