罗哌卡因复合舒芬太尼在硬脊膜穿破硬膜外分娩镇痛半数有效浓度的测定

Determination of 50%effective concentration of ropivacaine plus sufentanil in dural puncture epidural analgesia for labor

目的测定罗哌卡因复合舒芬太尼在硬脊膜穿破硬膜外分娩镇痛的半数有效浓度(EC_(50))。方法采用前瞻性研究方法,选择2021年5月至2022年5月在大连市妇女儿童中心(集团)要求行分娩镇痛的产妇60例,按照随机数字表法分为六组。分别给予罗哌卡因浓度0.05%(D1组)、0.06%(D2组)、0.07%(D3组)、0.08%(D4组)、0.09%(D5组)、0.10%(D6组)复合舒芬太尼0.3 mg/L。运用概率回归法(Probit)测定罗哌卡因复合舒芬太尼在硬脊膜穿破硬膜外分娩镇痛的EC_(50)及95%CI。记录产妇分娩镇痛前、给药后30 min的宫缩疼痛强度,用数字评分量表(NRS)评价,记录产妇的血压下降,心率减慢,恶心呕吐,分娩后头痛及胎心过缓的情况。结果测定罗哌卡因复合舒芬太尼在硬脊膜穿破硬膜外分娩镇痛EC_(50)为0.061%,95%CI 0.051~0.067,EC90为0.081%,95%CI 0.074~0.098。六组产妇中D3组有1例出现胎心过缓,D4组有1例出现心率减慢。所有六组产妇均未出现血压下降、恶心呕吐和术后头痛。结论测定罗哌卡因复合舒芬太尼在硬脊膜穿破硬膜外分娩镇痛EC_(50)为0.061%,95%CI 0.051~0.067,与硬膜外分娩镇痛EC_(50)相近。

Objective To determine the 50%effective concentration(EC_(50))of ropivacaine plus sufentanil for labor analgesia using the dural puncture epidural technique.Methods Using the method of prospective study,sixty parturients requiring labor analgesia in Dalian Women and Children′s Medical Group from May 2021 to May 2022 were divided into six groups using a random number table and administered 0.3 mg/L sufentanil and ropivacaine at different concentrations:0.05%(group D1),0.06%(group D2),0.07%(group D3),0.08%(group D4),0.09%(group D5),and 0.1%(group D6).A probit model was constructed to compute the EC_(50)values and 95%confidence intervals(95%CI)of ropivacaine plus sufentanil in dural puncture epidural analgesia(DPEA)for labor.The pain intensity of uterine contractions before labor analgesia and 30 min after administration was recorded and assessed on a numeric rating scale(NRS),and decreases in blood pressures and heart rates,vomiting and nausea,postpartum headaches,and fetal bradycardia were documented.Results When using ropivacaine plus sufentanil for labor analgesia via DPE,the EC_(50)was 0.061%,and the 95%CI ranged from 0.051 to 0.067;the 90%effective concentration(EC90)was 0.081%,and the 95%CI was between 0.074 and 0.098.Among the six groups,there was one case of fetal bradycardia in group D3 and one case of decreased heart rates in group D4.No decreased blood pressure,vomiting and nausea,or postpartum headaches were reported.Conclusions In DPEA for labor,ropivacaine plus sufentanil has an EC_(50)of 0.061%,with the 95%CI falling between 0.051 and 0.067,similar to the EC_(50)value in epidural analgesia.