左旋布比卡因在可行走式分娩镇痛中的应用

Levobupivacaine with fentanyl for walkable labor analgesia

关键词:  左旋布比卡因  分娩镇痛  硬膜外麻醉

Key words:  levobupivacaine  labor analgesia  epidural anesthesia

摘要:

［目的］观察0.1%的左旋布比卡因是否可完全避免对产妇下肢肌力的影响；如果0.1%左旋布比卡因的分娩镇痛效果不全，加入微量芬太尼是否可增强镇痛效果又不影响下肢肌力。［方法］60例符合条件的临产妇，按椎管内用药的不同随机分为IB组和IBF组。采用联合阻滞方法，蛛网膜下隙用药IB组是左旋布比卡因2.5 mg（2 mL）；IBF组是左旋布比卡因2.5 mg + 芬太尼20 μg（2 mL）。硬膜外导管接上微量泵，以12 mL/h的速度注入预先配制好的硬膜外药物，IB组药物为0.1%左旋布比卡因；IBF组为0.1%左旋布比卡因+1 μｇ/mL的芬太尼。［结果］两组间年龄、体重、身高、胎龄、镇痛前宫口大小、血压、心率、血氧饱和度差异均无显著性意义，分娩情况及新生儿Apger’ｓ评分差异也无显著性意义。LBF组ＶＡＳ平均第一产程为2.5±1.0，第二产程为3.5±1.5；LB组ＶＡＳ平均第一产程为5.5±1.0，第二产程为6.0±1.5，两组比较差异有显著性意义(P<0.05)。两组在各时段感觉阻滞范围、肌力方面呈共同变化趋势，无明显差异。搔痒发生率LBF组（16/30）明显高于LB（2/30）组（P<0.05）。［结论］采用联合阻滞方法，从蛛网膜下隙给予左旋布比卡因2.5 mg及芬太尼20 μg，然后以12 mL/ｈ的速度从硬膜外注入0.1%的左旋布比卡因加1 μｇ/mL的芬太尼，能达到可行走式分娩镇痛。

Abstract:

［Objective］Whether levobupivacaine 0.1% will avoid to block motor nerves. Whether it will increase the effect of analgesia when we add minim fentanyl in it.［Methods］Sixty nulliparous parturient in labor were recruited to receive different medicine in intrathecal with combined spinal epidural. IB group used 2.5 mg levobupivacaine (2 mL) and IBF group used 2.5 mg levobupivacaine + 20 μg fentanyl (2 mL) in subarachnoid. Then IB group used levobupivacaine 0.1% and IBF group used levobupivacaine 0.1%+1 μg/mL fentanyl with 12 mL/h in epidural.［Results］Both groups were similar in terms of age, weight, height, cervical dilatation score, SBP and SpO2, There were no differences in the mode of delivery and apgar status between the groups. VAS (visual analog scale) were significantly better in IB group 2.5±1.0 (first stage) and 3.5±1.5 (second stage) than in IB group 5.5±1.0(first stage) and 6.0±1.5 (second stage). Purities were significantly higher in group IBF than in group IB (16/30 vs. 2/30, P<0.05).［Conclusions］2.5 mg levobupivacaine + 20 μg fentanyl (2 mL) in subarachnoid and 0.1% levobupivacaine+1 μg/mL fentanyl with 12 mL/h in epidural is the optimal for walkable labor analgesia.