氢吗啡酮或芬太尼复合左布比卡因用于硬膜外分娩镇痛的疗效与不良反应观察

Efficacy and Adverse Reactions of Hydromorphone or Fentanyl Combined with Levobupivacaine in Epidural Labor Analgesia

关键词:  氢吗啡酮  左布比卡因  硬膜外  分娩镇痛

Key words:  ydromorphone  levobupivacaine  epidural  labor analgesia

摘要:

目的 比较氢吗啡酮或芬太尼复合左布比卡因用于硬膜外分娩镇痛的效果。方法 将100例足月初产妇随机分为2组（每组50例）：观察组采用20 μg·mL^-1氢吗啡酮复合0.1%左布比卡因硬膜外分娩镇痛；对照组采用2 μg·mL^-1芬太尼复合0.1%左布比卡因分娩镇痛。观察2组镇痛起效时间、疼痛强度、产程时间、分娩结局及血压和心率，并记录母婴并发症。评估新生儿Apgar评分，采集脐动脉血进行血气分析。结果 观察组镇痛起效时间明显快于对照组[（12.8±3.1） min vs（14.5±3.6） min，P<0.05]。在宫口开3~10 cm期间，观察组产妇疼痛视觉模拟评分（VAS）均显著低于对照组（P<0.05），但其他时刻VAS评分比较无统计学意义。2组产妇产程时间、分娩结局、血压、新生儿Apgar评分、脐动脉血pH比较均无统计学意义，且2组不良事件发生率相似。结论 与芬太尼比较，氢吗啡酮复合左布比卡因硬膜外分娩镇痛起效快，镇痛效果更强，不增加母婴并发症。

Abstract:

OBJECTIVE To compare the effects of hydromorphone and fentanyl with levobupivacaine for epidural analgesia during labor. METHODS One hundred nulliparous parturients were randomly divided into the two groups(50 in each group). The experimental group received 20 μg·mL^-1 hydromorphone plus 0.1% levobupivacaine, and control group received 2 μg·mL^-1 fentanyl plus 0.1% levobupivacaine for epidural analgesia. The onset of analgesia, pain intensity, labor duration, labor mode, Bromage scores, blood pressure and heart rate were recorded. Apgar scores and side effects of mothers and infants were also recorded. Umbilical arterial blood was drawn to analysis. RESULTS The onset time of analgesia was shorter in experiment group than that in control group[(12.8±3.1)min vs (14.5±3.6)min, P<0.05]. VAS was lower in experiment group at 3-10 cm of cervical dilatation than that in the control group(P<0.05). There were no significant differences in term of the labor duration, labor modes, blood pressure, heart rate, umbilical arterial blood pH and Apgar score between the groups during labor. The incidence of adverse events was similar between the 2 groups. CONCLUSION Compared with fentanyl, hydromorphone accelerates onset of analgesia and increases analgesic effects, and does not increase the adverse events of mother and baby.