腰麻-硬膜外联合麻醉和病人自控镇痛用于分娩镇痛的可行性

Feasibility of combined spinal-epidural anesthesia and patient controlled epidural analgesia for labour pain relief

目的 评价腰麻 硬膜外联合麻醉 (CSEA)和病人自控硬膜外镇痛 (PCEA)应用于分娩镇痛的可行性。方法 选择产程进入活跃期的单胎初产妇 6 0例 ,蛛网膜下腔注射丁哌卡因 2 5mg +芬太尼 2 5 μg后 30min ,PCEA输注 0 0 75 %丁哌卡因与 2 μg ml芬太尼的混合液 ,随机双盲分为三组 :A组为单次剂量 3ml,锁定时间 15min ;B组为单次剂量 3ml,锁定时间 15min ,输注速率 6ml h ;C组为输注速率 12ml h。另以 2 0例非镇痛产妇为对照组。于宫口开全时用改良荧光法测定各组的母体血浆儿茶酚胺 (CA) (肾上腺素和去甲肾上腺素 )的浓度。结果 三组分娩镇痛组间VAS无显著差异 (P>0 0 5 ) ,与对照组相比 ,均显著降低 (P <0 0 1)。A组与B组丁哌卡因用量比C组分别减少 6 5 % (P<0 0 1)和 2 5 % (P <0 0 5 )。A组芬太尼用量少于C组 ,但A组PCA次数多于B组 (P <0 0 5 )。B组、C组的母体血浆肾上腺素水平明显低于对照组 (P <0 0 1) ,产程、分娩方式的百分率、宫缩及运动神经阻滞程度组间无显著差异。结论 CSEA +PCEA是一安全有效的分娩镇痛方法。

Objective To evaluate the feasibility of combined spinal epidural anesthesia(CSEA) and patient controlled epidural analgesia (PCEA) for delivery analgesia Methods Sixty parturients in active advanced labour ,receiving spinal administration with bupivacaine 2 5mg and fentanyl 2 5μg and 30 min later with epidural mixture of 0 075% bupivacaine and 2μg/ml of fentanyl , were randomly double blindly allocated to receiving PCEA with the demand dose of 3ml and lockout interval of 15 min (group A ,n=20), continuous infusion at 6ml/h plus PCEA (group B,n=20),or a fixed rate continuous epidural infusion at 12ml/h (group C,n=20) Other 20 parturients without labour analgesia served as control group The maternal venous blood sample was taken at the cervical complete dilatation, to measure the plasma conentrations of catecholamine with the modified fluorophtometry Results There were not significant differences in VAS pain scores,stages of labour and mode of delivery among group A,B and C (P>0 05) VAS pain scores significantly decreased in group A ,B or C compared with those in control group (P<0 01) In comparison with that in group C, the required dose of bupivacaine decreased by 65% in group A(P<0 01)and 25% in group B (P<0 05) In group A the required dose of fentanyl was markedly lower than that in group C, but the demand boluses were much more than those in group B (P<0 05) The maternal plasma adrenine concentrations in group B and C were lower than those in control group (P<0 01) Conclusions CSEA combined with PCEA can be applied safely and effectively to labour pain relief