左旋布比卡因联合羟考酮在分娩镇痛中的应用

Effect of oxycodone combined with levobupivacaine on epidural labor analgesia

目的:观察左旋布比卡因联合羟考酮在硬膜外分娩镇痛中的效果。方法:84例拟行硬膜外分娩镇痛的初产妇随机分为羟考酮组(0.1%左旋布比卡因+0.2 mg/mL羟考酮)和芬太尼组(0.1%左旋布比卡因+2μg/mL芬太尼),每组42例。比较两组产妇各时间点视觉模拟量表(visual analogue scale/score,VAS)评分、改良Bromage评分、镇痛起效时间及首次患者自控硬膜外镇痛(patient-controlled epidural analgesia,PCEA)时间、产程时间、分娩方式、不良反应发生情况及新生儿Apgar评分、脐血血气分析。结果:两组产妇各时间点的VAS评分显著低于镇痛前,差异有统计学意义(P<0.05)。两组间各时间点的VAS评分比较,差异无统计学意义。镇痛起效时间羟考酮组显著短于芬太尼组,首次PCEA给药时间羟考酮组显著长于芬太尼组,差异均有统计学意义(P<0.05)。两组产妇Bromage评分、产程时间、分娩方式、不良反应发生情况以及新生儿Apgar评分、脐血血气分析比较,差异均无统计学意义(P>0.05)。结论:左旋布比卡因联合羟考酮能加快硬膜外镇痛起效时间,显著延长镇痛时间,不影响产程,也不增加母婴并发症,是一种安全有效的分娩镇痛方案。

Objective:To assess the effect of oxycodone combined with levobupivacaine on epidural analgesia for labor.Methods:A total of 84 parturients who were to receive epidural labor analgesia were divided into two groups randomly,with 42 patients in each group.The Group oxycodone received 0.1%levobupivacaine with 0.2 mg/mL oxycodone,and the Group fentanil received 0.1%levobupivacaine with 2μg/mL fentanil for epidural labor analgesia.The visual analogue scale/score(VAS),Bromage score,the onset time of analgesia,the first time of patient-controlled epidural analgesia(PCEA),labor duration,delivery mode,adverse reactions,Apgar score and umbilical cord blood gas analysis at each time point were observed.Results:The VAS at each time point in the two groups was lower than that before analgesia(P<0.05).There was no significant difference in the analgesia score at each time point between the two groups.The onset time of analgesia was shorter in Group oxycodone than that in Group fentanil(P<0.05).The first time of PCEA was longer in Group oxycodone than that in Group fentanil(P<0.05).There was no significant difference in Bromage score,labor duration,delivery mode,adverse reactions,Apgar score and umbilical cord blood gas between the two groups(P>0.05).Conclusion:Levobupivacaine combined with oxycodone could accelerate the onset time of analgesia and prolong the first time of PCEA.This combination contributes steady labor duration without increasing complications during labor.It is a safe and feasible strategy for labor analgesia.