浙江医学
浙江醫學
절강의학
ZHEJIANG MEDICAL JOURNAL
2013年
10期
905-908
,共4页
布比卡因%左旋布比卡因%罗哌卡因%镇痛%产科%硬膜外
佈比卡因%左鏇佈比卡因%囉哌卡因%鎮痛%產科%硬膜外
포비잡인%좌선포비잡인%라고잡인%진통%산과%경막외
Bupivacaine%Levobupivacaine%Ropivacaine%Analgesia%Obstetrical%Epidural
目的比较布比卡因、左旋布比卡因和罗哌卡因低浓度在硬膜外分娩镇痛中的效能.方法选取450例足月初产妇,按随机数字表法分为布比卡因组、左旋布比卡因组和罗哌卡因组,每组各150例.给予0.050%、0.075%、0.100%、0.125%和0.150%浓度的各组局麻药复合舒芬太尼0.5滋g/ml实施患者硬膜外自控分娩镇痛(PCEA)(各浓度30例).镇痛负荷量8 ml,背景量5 ml/h,PCEA量5 ml,锁定时间15 min.观察镇痛效果及记录产科相关情况.结果布比卡因、左旋布比卡因、罗哌卡因硬膜外分娩镇痛50%及95%有效浓度分别为0.043%和0.198%、0.055%和0.254%、0.058%和0.269%.镇痛效能相对中位数潜力(95%CI)分别为布比卡因/左旋布比卡因:0.7808(0.4601~1.1655),布比卡因/罗哌卡因:0.7378(0.4241~1.0980),左旋布比卡因/罗哌卡因:0.9449(0.6064~1.4251).logistc回归分析显示镇痛效果与局麻药浓度明显相关(OR=1.451,P<0.05),与局麻药种类无相关性(OR=0.576,P>0.05).结论硬膜外分娩镇痛时,3种局麻药镇痛效能相似,镇痛效果主要取决于药物浓度.
目的比較佈比卡因、左鏇佈比卡因和囉哌卡因低濃度在硬膜外分娩鎮痛中的效能.方法選取450例足月初產婦,按隨機數字錶法分為佈比卡因組、左鏇佈比卡因組和囉哌卡因組,每組各150例.給予0.050%、0.075%、0.100%、0.125%和0.150%濃度的各組跼痳藥複閤舒芬太尼0.5滋g/ml實施患者硬膜外自控分娩鎮痛(PCEA)(各濃度30例).鎮痛負荷量8 ml,揹景量5 ml/h,PCEA量5 ml,鎖定時間15 min.觀察鎮痛效果及記錄產科相關情況.結果佈比卡因、左鏇佈比卡因、囉哌卡因硬膜外分娩鎮痛50%及95%有效濃度分彆為0.043%和0.198%、0.055%和0.254%、0.058%和0.269%.鎮痛效能相對中位數潛力(95%CI)分彆為佈比卡因/左鏇佈比卡因:0.7808(0.4601~1.1655),佈比卡因/囉哌卡因:0.7378(0.4241~1.0980),左鏇佈比卡因/囉哌卡因:0.9449(0.6064~1.4251).logistc迴歸分析顯示鎮痛效果與跼痳藥濃度明顯相關(OR=1.451,P<0.05),與跼痳藥種類無相關性(OR=0.576,P>0.05).結論硬膜外分娩鎮痛時,3種跼痳藥鎮痛效能相似,鎮痛效果主要取決于藥物濃度.
목적비교포비잡인、좌선포비잡인화라고잡인저농도재경막외분면진통중적효능.방법선취450례족월초산부,안수궤수자표법분위포비잡인조、좌선포비잡인조화라고잡인조,매조각150례.급여0.050%、0.075%、0.100%、0.125%화0.150%농도적각조국마약복합서분태니0.5자g/ml실시환자경막외자공분면진통(PCEA)(각농도30례).진통부하량8 ml,배경량5 ml/h,PCEA량5 ml,쇄정시간15 min.관찰진통효과급기록산과상관정황.결과포비잡인、좌선포비잡인、라고잡인경막외분면진통50%급95%유효농도분별위0.043%화0.198%、0.055%화0.254%、0.058%화0.269%.진통효능상대중위수잠력(95%CI)분별위포비잡인/좌선포비잡인:0.7808(0.4601~1.1655),포비잡인/라고잡인:0.7378(0.4241~1.0980),좌선포비잡인/라고잡인:0.9449(0.6064~1.4251).logistc회귀분석현시진통효과여국마약농도명현상관(OR=1.451,P<0.05),여국마약충류무상관성(OR=0.576,P>0.05).결론경막외분면진통시,3충국마약진통효능상사,진통효과주요취결우약물농도.
Objective To compare the epidural analgesic potencies of bupivacaine, levobupivacaine and ropivacaine in patient-control ed labor analgesia. Methods Four hundred and fifty term nul iparous women were randomly assigned to re-ceive patient-control ed epidural labor analgesia with bupivacaine, levobupivacaine or ropivacaine combined with 0.5μg/ml sufentanil (n=150 in each group), and each group were divided into 5 subgroups with concentrations of 0.050%, 0.075%, 0.100%, 0.125% and 0.150%, respectively (n=30 in each subgroup). The initial bolus of the anesthetic solution was 8 ml, fol-lowed by continuous background infusion of 5 ml/h, bolus dose of 5 ml and a lockout of 15 min. The results of analgesia and obstetrics were recorded. Results No demographic and obstetric data differences were found among three groups(P>0.05). The 50% and 95% effective concentrations for epidural labor analgesia were 0.043% and 0.198% (bupivacaine), 0.055% and 0.254%(levobupivacaine), 0.058%and 0.269%(ropivacaine), respectively. The relative median potencies (95% CI) of three lo-cal anesthetics were bupivacaine/levobupivacaine: 0.7808 (0.4601~1.1655), bupivacaine/ropivacaine: 0.7378(0.4241~1.0980), and levobupivacaine/ropivacaine: 0.9449 (0.6064~1.4251). Logistic regression analysis showed that the analgesic effect was significantly related to the concentration of local anesthetics (OR=1.451, P<0.05), with a poor relation to the type of local anesthetic(OR=0.576, P>0.05). Conclusion The relative analgesic potencies of bupivacaine, levobupivacaine and ropivacaine are similar under epidural labor analgesia at low concentration. The analgesic effect mainly depends on the concentration of lo-cal anesthetics.
