硬膜外分娩镇痛时经产妇与初产妇罗哌卡因中位有效浓度的比较

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Comparison of median effective concentration of ropivacaine in multiparas or primiparas during epidural labor analgesia

背景与目的

分娩镇痛时初产妇局部麻醉药有效浓度中位数研究较多。然而,有关经产妇的研究较少。为探讨硬膜外分娩镇痛中经产妇的镇痛需求,本研究旨在探讨罗哌卡因与2ug/mL芬太尼用于经产妇硬膜外分娩镇痛的中位有效浓度。

方  法

本试验为前瞻性观察研究,共纳入初产妇和经产妇62名并分配到初产妇组和多产妇组。所有产妇均采用罗哌卡因联合2ug/mL芬太尼硬膜外分娩镇痛。用序贯法测定罗哌卡因的浓度,初始浓度设为0.1%,间隔为0.01%。硬膜外阻滞后30min,宫颈扩张2cm左右,用视觉模拟评分法(VAS)评价镇痛效果。采用序贯法计算罗哌卡因的中位有效浓度。疼痛强度用VAS评估。记录血流动力学参数、产程及新生儿Apgar评分。抽取脐动脉血进行血气分析,并记录副反应。

结 果  

初产妇硬膜外分娩镇痛时罗哌卡因的中位有效浓度为0.057%(95%CI:0.051-0.064%),经产妇硬膜外分娩镇痛时罗哌卡因的中位有效浓度为0.068%(95%CI:0.063-0.072%),两组比较有显著性差异(P=0.02)。

结 论

本研究表明,罗哌卡因复合芬太尼硬膜外分娩镇痛的中位有效浓度经产组较初产组增加,为0.068%(95%CI,0.063-0.072%)。

原始文献摘要

Qeng Q,  Yang Z,  Zhang W, etal;Comparison of median effective concentration of ropivacaine in multiparas or primiparas during epidural labor analgesia;Medicine (Baltimore) 2020 Jan;99(1);PMID:31895835.

Backgrand:The documents on the median effective concentration of local analgesic were many in primiparas during labor analgesia. However, the studies were fewer in multiparas. To explore the analgesic requirements in multiparas during epidural labor analgesia, we  investigated the median effective concentration of ropivacaine with 2ug/mL fentanyl for epidural labor analgesia in multiparas.

Methed:Sixty-two women were recruited and assigned to the primipara group and multipara group in this prospective study. All the parturients received ropivacaine combined with 2ug/mL fentanyl for epidural labor analgesia. The concentration of ropivacaine was determined by the up and down method and an initial concentration was set as 0.1% with a 0.01% interval. Effective analgesia was defifined as the visual analog scale (VAS) 3 within 30 minutes after epidural administration when cervical dilatation is about 2 cm. The median effective concentration of ropivacaine was calculated by the up and down sequential method. The pain intensity was assessed using VAS. Hemodynamic parameters, the labor stages, and neonatal Apgar scores were recorded. Umbilical artery blood was drawn to analyze. The side effects, if any, were also recorded.

Results:The median effective concentration of ropivacaine was 0.057% (95% confifidence interval [CI], 0.051–0.064%) in primiparas during epidural labor analgesia, and 0.068% (95% CI,0.063–0.072%) in multiparas during epidural labor analgesia, there was signifificant difference between the groups (P=0.02).

Conclusion:This study indicated that the median effective concentration of ropivacaine with fentanyl for epidural labor analgesia was 0.068% (95% CI, 0.063–0.072%) and increased in multiparas compared with the primiparas.

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贵州医科大学高鸿教授课题组

翻译:王贵龙  编辑:冯玉蓉  审校:王贵龙

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