| 徐 韬 王 莉 余大松 郑 静 王坚伟 卫 宇.腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量的临床研究[J].,2015,15(5):861-865 |
| 腰硬联合蛛网膜下腔注射芬太尼用于分娩镇痛的半数有效剂量的临床研究 |
| Clinical Research on the ED50 of Intrathecal Fentanyl Combined withEpidural Anesthesia in Labor |
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| DOI： |
| 中文关键词: 芬太尼 半数有效剂量 腰硬联合麻醉 分娩镇痛 硬膜外自 控镇痛 |
| 英文关键词: Fentanyl Median effective dose Combined spinal and epidural anesthesia Labor analgesia Epidural patient-controlled
analgesia |
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| 中文摘要: |
| 目的： 确定腰硬联合蛛网 膜下腔注射芬太尼用 于分娩镇痛 的半数有效剂 量(ED50)， 观察蛛网 膜下腔注射半数有效剂量芬太
尼的效果和副作用， 并与 蛛网 膜下腔注射半数有效剂 量的布比卡因 进行对比。 方法： 首先， 确定芬太尼用 于分娩镇痛的半数有效
剂 量， 筛 选 50 例 符合的产妇行腰硬联合分娩镇痛 ， 蛛网 膜下腔注射芬太尼的剂 量始于 25 滋g， 如果镇痛 有效， 下一病例 减少 2.5
滋g 芬太尼；如果无效则下一病例增加 2.5 滋g 芬太尼。 用 Probit 回归分析计算芬太尼蛛网 膜下腔注射行分娩镇痛的半数有效剂 量
和 95%可信区间 (95% CI)。 第二步， 筛选 1 00 例需要进行分娩镇痛的产妇，随机分入 ED50 芬太尼组(F 组)和 ED50 布比卡因 组(B
组)， 比较两组药物镇痛效果及起效时间、产妇下肢运动阻滞程度及血压心率变化、胎心变化和镇痛全程药物追加次数。 结果： 芬太
尼蛛网 膜下腔注射分娩镇痛的 ED50 为 1 1.5 滋g， 95% CI 为 3.5-1 5.4 滋g。 F 组镇痛 的平均起效时间 为 (12.0± 3.8) min， 两组镇痛 的
成功率没有统计学差异 (P=0.218)， F 组需要追加 PCA 的病例 百分率明显少于 B 组 (P=0.018)。 F 组下肢运动阻滞程度轻于 B 组
(P=0.01 8)。 两组镇痛方法对产妇的血压、心率均无明显影响。 两组胎心下降的发生率没有明显差异(P>0.05)。 F 组皮肤瘙痒的发生
率明显增加(P=0.000)。 结论： 腰硬联合分娩镇痛蛛网 膜下腔注射芬太尼的 ED50 为 11 .5 滋g， 95% CI 为 3.5-15.4 滋g。 蛛网 膜下腔注
射半数有效剂量的芬太尼可以提供简 便、持久、满意和安全的镇痛 效果， 并且对下肢运动阻滞程度较小， 但其所致皮肤瘙痒的发
生率升高。 |
| 英文摘要: |
| Objective:To determine the median effective dose of intrathecal fentanyl combined with epidural anesthesia in labor,
and observe its advantages and side effects.Methods:Firstly, 50 healthy parturients in labor were recruited for the dose-finding study. Initial dose of intrathecal fentanyl was 25 滋g. Doses varied in a 2.5 滋g testing interval according to up-down sequential allocation. An effective dose was directed to a decrement of 2.5 滋g fentanyl for the next patient. An inadequate dose was directed to an increase of 2.5 滋g
fentanyl for the next patient. The Probit Regression was used to estimate the ED50 dose of intrathecal fentanyl and its 95% confi- dence
intervals in labor analgesia. Secondly, another 1 00 healthy parurients were recruited and randomly allocated into fentanyl group(F group)
injected with a dose of ED50 fentanyl and bupivacaine group (B group) administered with a dose of ED50 bupivacaine. The anal- gesia
effect, onset time, motor block of lower limbs, rescue PCA, the effect on the blood pressure and heart rate of parturients and fetal were
compared between the two groups.Results:The ED50 ofintrathecal fentanyl was 11.5 滋g, and 95% CI is 3.5-15.4 滋g in labor analgesia. The
average onset time was (12.0± 3.8) min. There was no obvious difference in the achievement of adequate analgesia between the two
groups. Group F needs less rescued PCA than that of Group B. The degree of lower limbs motor block was less intense in fentanyl group
than that in bupivacaine group. There was no dramatic influence on parturients' heart rate and blood pressure in the two groups. There
was no marked difference in the incidence of fetal bradycardia. The occurrence of pruritus was more in fentanyl group than that in bupivacaine group.Conclusion:The median effective dose of intrathecal fentanyl in labor analgesia was 11 .5 滋g and 95% CI was 3.5-15.4
滋g. Intrathecal media effective dose of fentanyl could provide easy, long lasting, satisfactory and safe analgesia to parturients, and had
less blockage on the motor of lower limbs, but this method may induce pruritus which needn't medical treatment. |
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