分娩镇痛鞘内注射舒芬太尼最佳剂量的临床研究

摘要

目的 探讨鞘内首次注射舒芬太尼用于分娩镇痛的最佳剂量.方法 选择初产妇150例,随机分为A、B、C、D、E 5组,分娩镇痛时鞘内首次注射舒芬太尼分别为6 μg、7 μg、8 μg、9 μg和10 μg,Spinocath导管连续蛛网膜下腔给药维持.记录镇痛起效时间、镇痛起效后的1 h、3 h、5 h孕妇舒芬太尼血药浓度,测定新生儿脐带静脉血舒芬太尼血药浓度及不良反应等.结果 孕妇体内舒芬太尼血药浓度随着鞘内首次注射剂量的增大而增加(P＜0.01),注射剂量越大,血药浓度越高(P＜0.01);5组鞘内首次给药镇痛持续时间比较差异有统计学意义(P＜0.05),E组镇痛持续时间最长(P＜0.05);5组新生儿脐带血舒芬太尼血药浓度比较差异有统计学意义(P＜0.05),以E组最高(P＜0.05);E组孕妇皮肤瘙痒、恶心呕吐、尿潴留、嗜睡发生率及胎心改变发生率均高于其他4组(P＜0.05).结论 Spinocath导管连续蛛网膜下腔给药分娩镇痛时,鞘内首次注射舒芬太尼的最佳剂量是7～9 μg.%Objective To explore the best security dosage of sulfentanil used in the first intrathecal injection for labor analgesia. Methods One hundred and fifty pregnant women were randomly divided into 5 groups:Group A , Group B, Group C, Group D and Group E, whose dosage of sufentanil used in the first intrathecal injection were 6 μg, 7 μg,8 μg,9 μg and 10 μg,respectively. Continuous spinal anesthesia with Spinocath catheter was performed . Analgesic onset time,blood concentrations of sulfentanil of pregnant women 1,3 and 5 hours after analgesic onset were recorded , and blood concentrations of sulfentanil in the umbilical cord blood of the newborns and the adverse reactions were detec - ted. Results The blood concentration of sulfentanil of pregnant woman increased with the increase of the sulfentanil dosage in first intrathecal injection ( P < 0. 01) , and more dosage, higher blood concentration of sulfentanil ( P < 0. 01) ; The analgesic duration after the first intrathecal injection showed no significant difference among 5 groups(P <0. 05) , which in Group E was the longest ( P < 0. 05 ) ; The blood concentration of sulfentanil in the umbilical cord blood of the newborns showed significant difference among 5 groups (P <0. 05) , which in Group E was the highest (P <0. 05) ;The pruritus incidence,incidence of nausea and vomiting,incidence of urinary retention,incidence of somnolence,and incidence of fetal heart rate changes in Group E were higher than those in the other four groups ( P < 0. 05 ). Conclusion When sulfentanil is used in continuous spinal anesthesia with Spinocath catheter for labor ,the best security dosage of sulfentanil ranges from 7 μg to 9 μgin the first intrathecal injection.