论文部分内容阅读
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25μg,如果镇痛有效,下一病例减少2.5μg芬太尼;如果无效则下一病例增加2.5μg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100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11.5μg,95%CI为3.5-15.4μg。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=0.018)。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11.5μg,95%CI为3.5-15.4μg。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。
OBJECTIVE: To determine the effective dose (ED50) of epidural anesthesia combined with subarachnoid injection of fentanyl for labor analgesia and to observe the effects and side effects of subendocardial injection of fentanyl at half the effective dose and to compare with subarachnoid space Bupivacaine was injected at half the effective dose for comparison. Methods: Firstly, the effective dose of fentanyl for labor analgesia was determined. Fifty matched maternal patients were selected for analgesia combined with labor. The dosage of fentanyl injected into the subarachnoid was 25μg. If analgesia was effective , 2.5 μg fentanyl for the next case, and 2.5 μg fentanyl for the next case. Probit regression analysis was used to calculate the median effective dose and 95% confidence interval (95% CI) for analgesia during labor in fentanyl subarachnoid injections. In the second step, 100 women who needed labor analgesia were screened and randomly divided into ED50 fentanyl group (group F) and ED50 bupivacaine group (group B). The analgesic effect and the onset time of the two groups were compared , Maternal lower extremity motor block and blood pressure and heart rate changes, changes in fetal heart rate and the total number of drug analgesia appendages. Results: The ED50 of fentanyl subarachnoid injection labor analgesia was 11.5μg and the 95% CI was 3.5-15.4μg. The average time to onset of analgesia in group F was (12.0 ± 3.8) min, and there was no significant difference in the success rate of analgesia between the two groups (P = 0.218). The percentage of cases requiring additional PCA in group F was significantly less than that in group B (P = 0.018). F-group lower extremity motion block was lighter than the B group (P = 0.018). Two groups of analgesic methods on maternal blood pressure, heart rate had no significant effect. There was no significant difference in the incidence of fetal heart rate decline between the two groups (P> 0.05). The incidence of pruritus in group F increased significantly (P = 0.000). CONCLUSIONS: The ED50 of fentanyl for epidural analgesia combined with labor analgesia of the waist and abdomen is 11.5 μg and the 95% CI is 3.5-15.4 μg. Subarachnoid injection of fentanyl at a dose that is effective at half the dose provides a simple, long-lasting, satisfactory and safe analgesic effect with minimal blockade of lower extremities but with an increased incidence of pruritus.