蛛网膜下腔注射舒芬太尼用于布比卡因剖宫产术腰麻的50%和95%有效剂量

ED50 and ED95 of Intrathecal Sufentanil Co-Administered with Bupivacaine under Epidural Anesthesia for Cesarean Section

目的:探讨蛛网膜下腔注射舒芬太尼用于布比卡因剖宫产术腰麻的50%有效剂量(ED50)和95%有效剂量(ED95)。方法:选择拟在腰-硬联合麻醉(combined spinal-epidural anesthesia,CSEA)下进行子宫下段剖宫产术的足月产妇150例,年龄21～35岁,体质量60～90 kg,美国麻醉医师协会(American Society of Anesthesidogists,ASA)分级Ⅰ或Ⅱ级。随机分为5组,每组30例,各组给予布比卡因7 mg复合舒芬太尼,a组:舒芬太尼1μg;b组:舒芬太尼2.5μg;c组:舒芬太尼5μg;d组:舒芬太尼7.5μg;e组:舒芬太尼10μg。CSEA判定麻醉成功的标准是腰麻注药后10 min内双侧感觉阻滞平面达到T6水平以及整个手术过程中硬膜外腔无需追加麻醉药。判定麻醉失败的标准是10 min内双侧感觉阻滞平面未达到T6水平,或目测类比评分法(visual analogue scale,VAS)≥2,手术过程中产妇主动要求硬膜外腔追加麻醉药。记录腰麻注药后5、10 min(T1、T2)时的痛觉消失平面和运动阻滞程度;双侧感觉阻滞平面达到T6水平的时间;麻醉后24 h内皮肤瘙痒、寒颤、恶心、呕吐的发生情况;新生儿Apgar评分。结果:麻醉成功例数随舒芬太尼剂量的增加而增加,组间比较差异有统计学意义(P<0.05)。感觉阻滞平面达T6时间随舒芬太尼剂量增加而缩短,组间比较差异有统计学意义(P<0.05);皮肤瘙痒和恶心、呕吐发生率随舒芬太尼剂量增加而增加,组间比较差异有统计学意义(P<0.05)。舒芬太尼蛛网膜下腔注射混合布比卡因7 mg用于剖宫产术腰麻的ED50为2.7μg[95%可信区间(confidence interval,CI):0～4.4μg)]、ED95为15.7μg(95%CI:11.7～27.7μg)。结论:蛛网膜下腔注射舒芬太尼用于布比卡因剖宫产术腰麻的ED50和ED95分别是2.7μg(95%CI:0～4.4μg)、15.7μg(95%CI:11.7～27.7μg)。

Objective：To investigate the ED50 and ED95 of intrathecal sufentanil co-administered with bupivacaine under epidural anesthesia for cesarean section.Methods：A total of 150 patients have been enrolled.Their ASA physical status class wereⅠorⅡ;their ages ranged from 21 to 35 years old;their weight ranged from 60 to 90 kg;all of the 150 full term pregnant women were in schedule for cesarean section under combined spinal-epidural anesthesia（CSEA）.They were randomly divided into 5 groups.Patients were allocated to one of five possible groups to receive 1,2.5,5,7.5,10 μg intrathecal sufentanil co-administered with bupivacaine 7 mg（make the total volume 3 mL）.A successful block was defined as a bilateral sensory level to pinprick to T6 within 10 min without additional epidural anesthetic required during surgery.A failure was recorded when a T6 sensory level was not obtained within 10 min after intrathecal anesthetic administration,or when supplemental epidural analgesia was required to complete surgery because of either patient′s request for additional analgesia or the visual analogue scale（VAS）≥2.The sensory level and motor block was determined at 5,10 min（T1,T2）.The time for bilateral T6 sensory level was recorded.Pruritus,shivers,nausea and vomiting were recorded.Neonatal Apgar score was recorded after delivery.Results： There were significant differences among groups as the rates of success for a bilateral T6 sensory level and the mean time to T6 sensory block onset were different among groups with the increase of sufentanil dose.There were significant differences among groups in the rates of pruritus,nausea and vomiting.When combined with intrathecal bupivacaine 7 mg,the ED50 of intrathecal sufentanil was 2.7 μg95 % confidence interval（CI）：0~4.4 μg,and the ED95 was 15.7 μg（95 %CI：11.7~27.7 μg） for cesarean section.Conclusions： When co-administered with intrathecal bupivacaine 7 mg,the ED50 of sufentanil is 2.7 μg（95 % CI：0-4.4 μg） and the ED95 is 15.7 μg（95 % CI：11.7-27.7 μg）.