羟考酮复合左布比卡因用于硬膜外分娩镇痛的尝试性研究<

Effects of Adding Oxycodone to Levobupivacaine on Epidural Labor Analgesia: A Pilot Study

关键词:  羟考酮  左布比卡因  硬膜外  分娩镇痛

Key words:  oxycodone  levobupivacaine  epidural  labor analgesia

摘要:

目的 探讨羟考酮复合左布比卡因用于硬膜外分娩镇痛的安全性和效果。方法 100例单胎足月初产妇随机分为2组：观察组50例采用0.2 mg·mL^-1羟考酮复合0.1%左布比卡因硬膜外分娩镇痛；对照组50例采用2 μg·mL^-1芬太尼复合0.1%左布比卡因硬膜外分娩镇痛。观察2组镇痛起效时间、镇痛持续时间、产程时间、分娩方式、血压及镇痛效果，评估新生儿Apgar评分，采集脐动脉血进行血气分析，并记录母婴并发症。结果 2组产妇镇痛后疼痛视觉模拟评分（VAS）均显著低于镇痛前（P<0.01），但是2组间第一产程中VAS评分比较有统计学意义（P<0.05）。2组产妇镇痛起效时间、产程时间、分娩方式、Bromage评分、新生儿Apgar评分、脐动脉血气比较均无统计学意义，但观察组镇痛持续时间明显长于观察组[（6.2±1.4）h vs（1.1±0.3）h，P<0.01]。观察组产妇皮肤瘙痒发生率明显高于对照组（16% vs 2%，P<0.05）。结论 羟考酮复合左布比卡因硬膜外分娩镇痛效果优于芬太尼，且作用时间久，不影响产程，对新生儿无明显影响，但皮肤瘙痒发生率明显增加。

Abstract:

OBJECTIVE To investigate the safety and effects of adding oxycodone to levobupivacaine on epidural analgesia during labor. METHODS One hundred pregnancy nulliparous parturients were randomly divided into 2 groups. The experimental group received 0.2 mg·mL^-1 oxycodone plus 0.1% levobupivacaine and the control group received 2 μg·mL^-1 fentanyl plus 0.1% levobupivacaine for epidural analgesia. The onset of analgesia, the duration of analgesia, labor duration, labor mode, blood pressure, Apgar scores of neonate and analgesic effect. Umbilical arterial blood was collected to analysis. The adverse effects were also recorded. RESULTS VAS was lower than that before analgesia in both groups(P<0.01). However, the VAS score in the first stage of labor between the 2 groups was statistically significant(P<0.05). There were no significant differences in term of the onset of analgesia, labor duration, Bromage scores, labor mode, blood gas of umbilical arterial blood and Apgar score between the groups during labor, but the duration of analgesia was longer in experiment group than that in control group[(6.2±1.4)h vs (1.1±0.3)h, P<0.01]. The incidence of pruritus was higher in experiment group than in control group(16% vs 2%, P<0.05). CONCLUSION Levobupivacaine with oxycodone has good analgesic effect and lasting duration of analgesia, and does not affect labor duration and the neonate, but increases the incidence of pruritus.