不同浓度罗哌卡因复合布托啡诺行硬膜外分娩镇痛的量效观察

中国临床药理学与治疗学 ›› 2013, Vol. 18 ›› Issue (10): 1126-1131.

不同浓度罗哌卡因复合布托啡诺行硬膜外分娩镇痛的量效观察

陈兰凤^1,2, 金豪杰¹, 高宝斌¹, 卢园园², 李军²

¹舟山市妇幼保健院麻醉科,舟山 316000,浙江;
²温州医科大学附属第二医院麻醉科,温州 325027,浙江

收稿日期:2013-05-10 修回日期:2013-09-08 出版日期:2013-10-26 发布日期:2013-09-30
通讯作者: 李军,男,博士,教授,主任医师,研究方向:麻醉药理学及围术期脏器保护。Tel: 0577-88002925 E-mail: lijun0068@163.com
作者简介:陈兰凤,女,主治医师,在职硕士研究生,研究方向:产科麻醉。Tel: 13665810654 E-mail: alice830215@163.com

A concentration-response observation of butorphanol combined with ropivacaine in labor epidural analgesia

CHEN Lan-feng^1,2, JIN Hao-jie¹, GAO Bao-bin¹, LU Yuan-yuan², LI Jun²

¹Department of Anesthesiology, Matermal and Child Health care Hospital of Zhoushan City, Zhoushan 316000, Zhejiang,China;
²Department of Anesthesiology, The 2nd Affiliated Hospital of Wenzhou Medical College, Wenzhou 325027, Zhejiang,China

Received:2013-05-10 Revised:2013-09-08 Online:2013-10-26 Published:2013-09-30

摘要/Abstract

摘要： 目的:探讨罗哌卡因复合布托啡诺行硬膜外分娩镇痛时布托啡诺的半数有效剂量(ED₅₀)和罗哌卡因的最佳有效浓度。方法:121例初产妇接受L2-3硬膜外分娩镇痛,前31例患者中第一个患者接受 0.15%罗哌卡因+20 μg/mL 布托啡诺复合液,随后的产妇运用改良序贯法确定布托啡诺的ED₅₀。另90例患者按硬膜外用药不同随机分为 0.08%罗哌卡因+16 μg/mL 布托啡诺(B1组)、0.10%罗哌卡因+16 μg/mL 布托啡诺(B2组)及 0.12%罗哌卡因+16 μg/mL 布托啡诺(B3组)。监测分娩镇痛过程中阻滞平面和运动阻滞(Bromage评分)、镇静镇痛评分及宫缩胎心;记录麻醉起效时间、产程时间、分娩方式、缩宫素使用增加例数以及新生儿Apgar评分,记录恶心、呕吐、瘙痒、胎心减速等副作用发生率。结果:布托啡诺的ED₅₀值及ED₉₅值分别为14.79(95%CI 13.91~15.61)和 16.84(95%CI 15.86~20.97) μg/mL。B1组镇痛起效时间明显长于B2、B3组(P<0.05),给药后30、60和 90 min 时的VAS评分明显高于B2、B3组,停药时VAS评分明显高于B3组(P<0.05);B1组在镇痛后第4~6次宫缩时的VAS评分明显高于B2、B3组(P<0.05)。B3组运动神经阻滞发生的例数明显高于B1、B2组(P<0.05)。结论:0.10%罗哌卡因复合16 μg/mL布托啡诺行分娩镇痛时镇痛效果好、无运动阻滞、安全性高,值得临床推广。

关键词: 罗哌卡因, 布托啡诺, 分娩镇痛

Abstract: AIM: To investigate the ED₅₀ of butorphanol combined with 0.15% ropivacaine and the most effective concentration of ropivacaine combined with butorphanol in labor epidural analgesia.METHODS: 121 nulliparous women undergoing labor selected for delivery with epidural analgesia. The first of the top 31 woman received 0.15% ropivacaine plus 20 μg/mL butorphanol 10 mL, the next woman's dose of the butorphanol was determined by a modification of sequential method. The other 90 women received 0.08% ropivacaine and butorphanol 16 μg/mL (Group B1), 0.10% ropivacaine and butorphanol 16 μg/mL (group B2), 0.12% ropivacaine and butorphanol 16 μg/mL(group B3) respectively.In the course of labor, block levels of epidural analgesia, the Bromage scores, Ramsay scores, fetal heart rate-uterine contraction were monitored. In addition, onset time of anesthesia, labor time, the cases of oxytocin using, Apgar scores of neonates and side-effect were recorded.RESULTS: There were no significant differences in age, height, weight and gestational weeks in every woman.The ED₅₀ of butorphanol was 14.79 μg/mL (95%CI 13.91～15.61 μg/mL). The ED₉₅ of butorphanol was 16.84 μg/mL (95%CI 15.86～20.97 μg/mL). The onset of anesthesia in group B1 was significantly longer than other two groups (P<0.05). The VAS scores at 30 min, 60 min, 90 min after injection in group B1 was significantly higher than those in other two groups(P<0.05), and the VAS scores when drug withdraw in group B1 was significantly higher than those in group B3(P<0.05). Group B3 showed higher motor block than other two groups (P<0.05).CONCLUSION: 0.10% ropivacaine combined with butorphanol 16 μg/mL is the most effective for epidural analgesia in labor. It is worth clinical application for its kind analgesic effect, slight motor block and high safety.

Key words: Ropivacaine, Butorphanol, Labor analgesia

中图分类号:

R971⁺.2

陈兰凤, 金豪杰, 高宝斌, 卢园园, 李军. 不同浓度罗哌卡因复合布托啡诺行硬膜外分娩镇痛的量效观察[J]. 中国临床药理学与治疗学, 2013, 18(10): 1126-1131.

CHEN Lan-feng, JIN Hao-jie, GAO Bao-bin, LU Yuan-yuan, LI Jun. A concentration-response observation of butorphanol combined with ropivacaine in labor epidural analgesia[J]. Chinese Journal of Clinical Pharmacology and Therapeutics, 2013, 18(10): 1126-1131.

参考文献

[1] Pokharel K, Rahman TR, Singh SN, et al. The efficacy and safety of low dose epidural butorphanol on postoperative analgesia following cesarean delivery[J]. JNMA J Nepal Med Assoc,2008,47(170):57-61.
[2] Gupta R, Kaur S, Singh S, et al. A comparison of epidural butorphanol and tramadol for postoperative analgesia using CSEA technique[J]. J Anaesthesiol Clin Pharmacol,2011,27(1):35-38.
[3] 喻君,郭建荣,金孝岠.氯诺昔康与布托啡诺用于腹腔镜胆囊切除术后镇痛效果[J].中国临床药理学与治疗学,2008,13(3):340-343.
[4] 金丕焕.医用统计方法[M]. 2版. 上海:复旦大学出版社,2003:305-308.
[5] 陈伯鉴.临床麻醉药理学[M]. 北京:人民卫生出版社,2000:29-31.
[6] Stewart A, Fernando R. Maternal ambulation during labor [J]. Curr Opin Anaesthesiol, 2011, 24(3):268-273.
[7] Hawkins JL. Epidural Analgesia for Labor and Delivery [J]. N Engl J Med, 2010, 362(16):1503-1510.
[8] Beilin Y. An update on obstetric anesthesia [J]. Semin Cardiothorac Vasc Anesth, 2010, 14(1):64-65.
[9] Chu CC, Chen JY, Chea CS, et al. The efficacy and safety of transnasal butorphanol for post operative pain control following lower laparoscopic surgery[J].Acta anaesthesia Taiwan,2004, 42(4):2034.
[10] Makkar JK, Arora S, Jain K, et al. ED50 of desflurane for laryngeal mask airway removal in anaesthetised adults[J]. Anaesthesia, 2011, 66(9): 808-811.
[11] Hang LH, Shao DH, Gu YP. The ED50 and ED95 of ketamine for prevention of postoperative hyperalgesia after remifentanil-based anaesthesia in patients undergoing laparoscopic cholecystectomy[J]. Swiss Med Wkly, 2011, 141:w13195.
[12] Sah N, Vallejo M, Phelps A, et al. Efficacy of ropivacaine, bupivacaine, and levobupivacaine for labor epidural analgesia[J]. J Clin Anesth, 2007, 19(3):214-217.
[13] Lee HL, Lo LM, Chou CC, et al. Comparison between 0.08% ropivacaine and 0.06% levobupivacaine for epidural analgesia during nulliparous labor: a retrospective study in a single center[J]. Chang Gung Med J, 2011, 34(3):286-292.

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