上海交通大学学报（医学版）

上海交通大学学报（医学版）

• 论著（临床研究） • 上一篇    下一篇

序贯法测定罗哌卡因复合舒芬太尼硬膜外分娩镇痛的最小有效浓度

沈婷，郑静   

  1. 上海交通大学 医学院附属国际和平妇幼保健院麻醉科， 上海 200030
  • 出版日期:2016-02-28 发布日期:2016-03-29
  • 通讯作者: 郑静, 电子信箱: autumnauther@163.com。
  • 作者简介:沈婷（1986—)， 女， 硕士， 住院医师; 电子信箱: stanna_100@163.com。

Determination of the minimum local analgesic concentration of ropivacaine for the application of ropivacaine combined with sufentanil to epidural labor analgesia by sequential allocation method

SHEN Ting, ZHENG Jing   

  1. Department of Anesthesiology, International Peace Maternity and Child Health Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
  • Online:2016-02-28 Published:2016-03-29

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摘要：

目的 利用序贯法测定罗哌卡因复合舒芬太尼用于第一及第二产程硬膜外分娩镇痛时，罗哌卡因的最小有效镇痛浓度（MLAC），并观察其不良反应。 方法 选择30例单胎足月初产妇，第一产程宫口开至3 cm后行硬膜外镇痛，起始浓度为0.1%罗哌卡因复合舒芬太尼0.3 μg/mL。根据前一例产妇的镇痛效果，上调或下调0.01%的罗哌卡因浓度作为后一例产妇的镇痛浓度。用药后30 min至第二产程结束的视觉模拟疼痛评分（VAS）≤3分为有效。通过Brownlee上下序贯法计算出罗哌卡因的MLAC及95%CI。结果 第一产程及第二产程硬膜外分娩镇痛罗哌卡因的MLAC为0.092 3%，95%CI为0.091 8%~0.092 8%。有5例产妇出现恶心呕吐，发生率为16.7%；1例出现皮肤瘙痒，发生率为3.3%。结论 使用罗哌卡因复合舒芬太尼0.3 μg/mL用于第一及第二产程硬膜外分娩镇痛时，罗哌卡因的MLAC为0.092 3%。

关键词: 罗哌卡因, 舒芬太尼, 硬膜外分娩镇痛, 剂量效应关系

Abstract:

Objective To determine the minimum local analgesic concentration (MLAC) of ropivacaine for the application of ropivacaine combined with sufentanil to epidural analgesia at the first and the second stage of labor by sequential allocation method and observe its adverse reactions. Methods A total of 30 nulliparous full-term primiparas were enrolled. The epidural analgesia was performed when cervical dilation reached 3 cm at the first stage of labor. The initial concentration of ropivacaine was 0.1% combined with sufentanil of 0.3 μg/mL. According to the response of the previous primipara, the concentration of ropivacaine was increased or decreased by 0.01% for the next primipara. The analgesia was defined as effective if the visual analogue scale (VAS) score was no more than 3 from 30 min after administration to the end of the second stage of labor. The Brownlee up-and-down sequential allocation was used to calculate the MLAC and 95%CI of ropivacaine. Results For epidural analgesia at the first and the second stage of labor, the MLAC and 95%CI of ropivacaine were 0.092 3% and 0.091 8%-0.092 8%. Five primiparas had PONV and the incidence was 16.7%. One primipara had pruritus and the incidence was 3.3%. Conclusion The MLAC of ropivacaine is 0.092 3% when applying ropivacaine with sufentanil of 0.3 μg/mL to epidural analgesia at the first and the second stage of labor.

Key words: ropivacaine, sufentanil, epidural labor analgesia, dose effect relation