羟考酮对罗哌卡因硬膜外分娩镇痛的影响
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摘要
目的探讨羟考酮复合罗哌卡因用于硬膜外分娩镇痛的安全性和有效性。方法选择2017年2月至2018年1月国际和平妇幼保健院的112例初产妇,年龄21～35岁。随机分为2组:观察组(A组,n=57)采用0.1%罗哌卡因复合羟考酮硬膜外分娩镇痛;对照组(B组,n=55)采用0.1%罗哌卡因硬膜外分娩镇痛。观察两组起效时间、作用持续时间、镇痛效果、产程时间、分娩结局及血流动力学指标,记录母婴不良反应,评估新生儿Apgar评分,进行脐动脉血气分析。结果 A组镇痛起效时间快于B组,镇痛作用维持时间长于B组。两组产妇在镇痛后疼痛视觉模拟评分(visual analogue score,VAS)低于镇痛前(P<0.05);A组镇痛后2 h至宫口开全的镇痛效果明显优于B组,两组VAS评分差异有统计学意义(P<0.05)。比较两组产妇产程时间、分娩结局、Bromage评分、新生儿Apgar评分及脐动脉血气分析,差异均无统计学意义。两组产妇均无严重不良反应。结论羟考酮能加快硬膜外镇痛起效时间,显著延长镇痛时间,增强硬膜外镇痛效果,且不影响产程,也不增加母婴并发症。
Objective To investigate the effect of oxycodone on epidural ropivacaine analgesia during labor. Methods From Feb.,2017 to Jan.,2018 in International Peace Maternity and Child Health Hospital,112 pregnancy nulliparous parturients were assigned randomly to two groups.The experiment group(group A,n=57) received 0.1% ropivacaine with 2 mg oxycodone,and the control group(group B,n=55) received 0.1% ropivacaine alone for labor analgesia.We observed the onset time of analgesia,duration of analgesia,labor duration,analgesia efficacy and hemodynamics index,and recorded Apgar scores and adverse reactions.The neonatal umbilical artery blood gas was analyzed. ResultsThe onset time of analgesia was shorter in group A than that in group B.The duration of analgesia was longer in group A than that in group B.Visual analogue score(VAS) was lower in group A than that in group B from 2 h after analgesia to the full dilation of cervix,and the difference of VAS between the two groups had statistical significance(P<0.05).There was no significant differences in labor duration,Bromage scores,labor mode,blood pressure,blood gas analysis of neonatal umbilical artery and Apgar score between the two groups.No parturients had serious adverse effects in both groups.Conclusions Oxycodone with ropivacaine could accelerate the onset time of analgesia,prolong duration of analgesia and increase analgesic effect,but did not affect labor duration or increase adverse reaction during labor.
Objective To investigate the effect of oxycodone on epidural ropivacaine analgesia during labor. Methods From Feb.,2017 to Jan.,2018 in International Peace Maternity and Child Health Hospital,112 pregnancy nulliparous parturients were assigned randomly to two groups.The experiment group(group A,n=57) received 0.1% ropivacaine with 2 mg oxycodone,and the control group(group B,n=55) received 0.1% ropivacaine alone for labor analgesia.We observed the onset time of analgesia,duration of analgesia,labor duration,analgesia efficacy and hemodynamics index,and recorded Apgar scores and adverse reactions.The neonatal umbilical artery blood gas was analyzed. ResultsThe onset time of analgesia was shorter in group A than that in group B.The duration of analgesia was longer in group A than that in group B.Visual analogue score(VAS) was lower in group A than that in group B from 2 h after analgesia to the full dilation of cervix,and the difference of VAS between the two groups had statistical significance(P<0.05).There was no significant differences in labor duration,Bromage scores,labor mode,blood pressure,blood gas analysis of neonatal umbilical artery and Apgar score between the two groups.No parturients had serious adverse effects in both groups.Conclusions Oxycodone with ropivacaine could accelerate the onset time of analgesia,prolong duration of analgesia and increase analgesic effect,but did not affect labor duration or increase adverse reaction during labor.
引文
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[11] 周淑珍,林增茂,孙丙亮,等.个体化镇痛时机对硬膜外分娩镇痛效果的影响[J].临床麻醉学杂志,2018,34(4):317-321.
[12] 王永琴,魏兴武,逯金祥,等.连续硬膜外阻滞分娩镇痛联合产程管理对母婴的影响[J].现代妇产科进展,2017,26(5):373-377.
[13] 卢园园,黄璜,毛卫亮,等.氢吗啡酮复合罗哌卡因用于分娩镇痛的量效研究[J].中华医学杂志,2017,97(42):3297-3300.
[14] 白云波,徐铭军,车向明,等.闭环反馈自动给药分娩镇痛泵用于分娩镇痛的临床研究[J].国际麻醉学与复苏杂志,2018,39(4):333-337.
[15] 杨絮,杨泳,吕国义.硬膜外分娩镇痛对经阴道分娩母婴影响的临床研究[J].临床医学,2015,35(4):9-12.
[16] 郑明芳.低浓度罗哌卡因联合舒芬太尼椎管内阻滞用于分娩镇痛的效果分析[J].中国现代药物应用,2017,11(13):109-111.
[17] 杨世辉,孙艺娟,陈祥楠,等.不同产程硬膜外分娩镇痛对分娩镇痛的影响[J].广东医学,2014,35(4):1022-1024.
[18] 鲁恒,黄绍强, 胡建英,等.低浓度与超低浓度罗哌卡因间断硬膜外给药用于分娩镇痛的效果及对产科结局的影响[J].复旦学报(医学版),2017,44(4):498-502.
[2] STAAHL C,CHRISTRUP LL,ANDERSEN SD,et al.A comparative study of oxycodone and morphine in a multi-modal,tissue-differentiated experimental pain model [J].Pain,2006,123 (1):28-36.
[3] SULTAN P,HALPERN SH,PUSHPANATHAN E,et al.The effect of intrathecal morphine dose on outcomes after elective cesarean delivery:a meta-analysis [J].Anesth Analg,2016,123(1):154-164.
[4] DING Z,WANG K,WANG B,et al.Efficacy and tolerability of oxycodone versus fentanyl for intravenous patient-controlled analgesia after gastrointestinal laparotomy:a prospective,randomized,double-blind study[J].Medicine (Baltimore),2016,95(39):e4943.
[5] YANAGIDATE F,DOHI S.Epidural oxycodone or morphine following gynaecological surgery[J].Br J Anaesth,2004,93(3):362-368.
[6] OLKKOLA KT,KONTINEN VK,SAARI TI,et al.Does the pharmacology of oxycodone justify its increasing use as an analgesic?[J].Trends Pharmacol Sci,2013,34(4):206-214.
[7] PIIRAINEN P,KOKKI H,HAUTAJ?RVI H,et al.The analgesic efficacy and pharmacokinetics of epidural oxycodone after gynaecological laparotomy:a randomized,double-blind,double-dummy comparison with intravenous administration[J].Br J Clin Pharmacol,2018,84(9):2088-2096.
[8] 李勇晓,孟凡民.瑞芬太尼和盐酸羟考酮用于静脉分娩镇痛的临床研究[J].中国实用医刊,2016,43(24):65-68.
[9] OLCZAK B,KOWALSKI G,LEPPERT W,et al.Analgesic efficacy and safety of epidural oxycodone in patients undergoing total hip arthroplasty:a pilot study[J].J Pain Res,2017,10(10):2303-2309.
[10] 李铁建.不同浓度罗哌卡因复合芬太尼用于分娩镇痛的临床效果研究[J].中国妇幼保健,2018,33(16):3818-3820.
[11] 周淑珍,林增茂,孙丙亮,等.个体化镇痛时机对硬膜外分娩镇痛效果的影响[J].临床麻醉学杂志,2018,34(4):317-321.
[12] 王永琴,魏兴武,逯金祥,等.连续硬膜外阻滞分娩镇痛联合产程管理对母婴的影响[J].现代妇产科进展,2017,26(5):373-377.
[13] 卢园园,黄璜,毛卫亮,等.氢吗啡酮复合罗哌卡因用于分娩镇痛的量效研究[J].中华医学杂志,2017,97(42):3297-3300.
[14] 白云波,徐铭军,车向明,等.闭环反馈自动给药分娩镇痛泵用于分娩镇痛的临床研究[J].国际麻醉学与复苏杂志,2018,39(4):333-337.
[15] 杨絮,杨泳,吕国义.硬膜外分娩镇痛对经阴道分娩母婴影响的临床研究[J].临床医学,2015,35(4):9-12.
[16] 郑明芳.低浓度罗哌卡因联合舒芬太尼椎管内阻滞用于分娩镇痛的效果分析[J].中国现代药物应用,2017,11(13):109-111.
[17] 杨世辉,孙艺娟,陈祥楠,等.不同产程硬膜外分娩镇痛对分娩镇痛的影响[J].广东医学,2014,35(4):1022-1024.
[18] 鲁恒,黄绍强, 胡建英,等.低浓度与超低浓度罗哌卡因间断硬膜外给药用于分娩镇痛的效果及对产科结局的影响[J].复旦学报(医学版),2017,44(4):498-502.