国际麻醉学与复苏杂志   2022, Issue (7): 0-0
    
硬膜外程控脉冲输注0.08%罗哌卡因复合 0.3 mg/L舒芬太尼用于分娩镇痛最佳脉冲容量的研究
周双琼, 王菁, 陈小芬, 曹秀红, 宋玉洁, 徐振东, 刘志强1()
1.上海市第一妇婴保健院
Determination of the optimal programmed intermittent epidural bolus volume of ropivacaine 0.08% with sufentanil 0.3 mg/L for labor analgesia
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摘要:

目的 探讨硬膜外程控脉冲输注(programmed intermittent epidural bolus, PIEB)0.08%罗哌卡因复合0.3 mg/L舒芬太尼为90%产妇第一产程提供有效镇痛的最佳脉冲容量。 方法 根据偏倚硬币序贯(biased coin up‑and‑down, BCUD)法对40例硬膜外分娩镇痛的初产妇进行前瞻性、双盲序贯研究。PIEB药物为0.08%罗哌卡因复合0.3 mg/L舒芬太尼,间隔时间45 min。根据BCUD法,PIEB脉冲容量设定为8、9、10、11、12 ml,分别对应8 ml组、9 ml组、10 ml组、11 ml组、12 ml组。首例PIEB给药容量设定为8 ml,下一位产妇给药容量由前一位产妇的分娩镇痛效果决定。主要结局指标是设定的脉冲容量为对应产妇提供的有效镇痛。次要结局指标包括感觉阻滞平面、运动阻滞程度、低血压及瘙痒的发生情况。采用truncated Dixon‑Mood法及Isotonic回归分析法估计90%有效容量(90% effective volume, EV90)及其95%CI。 结果 设定的脉冲容量为32例产妇提供了有效镇痛。根据产妇有效镇痛结果,truncated Dixon‑Mood法及Isotonic回归分析法估计的EV90分别为10.53 ml(95%CI 9.18~11.87 ml)和10.76 ml(95%CI 10.30~11.82 ml)。共有3例产妇感觉阻滞平面高于T6,其中11 ml组1例,12 ml组2例;而10 ml组、9 ml组和8 ml组中所有产妇感觉阻滞平面低于T6。所有产妇均未发生低血压及运动阻滞。10 ml组、12 ml组各有1例产妇出现皮肤瘙痒。 结论 采用 PIEB模式进行分娩镇痛,当给药间隔设定为45 min时,0.08%罗哌卡因复合0.3 mg/L舒芬太尼的EV90不低于10 ml。

关键词: 偏倚硬币序贯法; 分娩镇痛; 硬膜外程控脉冲输注; 第一产程
Abstract:

Objective Determining the optimal bolus volume for programmed intermittent epidural bolus (PIEB) using ropivacaine 0.08% and sufentanil 0.3 mg/L to provide adequate analgesia in 90% of women during the first stage of labor. Methods A prospective, double‑blind dose‑finding study was conducted on 40 nulliparous parturients with epidural labor analgesia according to the biased coin up‑and‑down sequential allocation method. The PIEB interval was fixed at 45 min with 0.08% ropivacaine and 0.3 mg/L sufentanil. Participants were divided into groups 8 ml, 9 ml, 10 ml, 11 ml, and 12 ml according to the PIEB volume (8, 9, 10, 11 ml and 12 ml, respectively). The PIEB volume of the first parturient was set at 8 ml, and that of the subsequent parturient varied according to the labor analgesia effect of the previous parturient. The primary outcome was the adequate analgesia provided by the bound PIEB volume for the corresponding parturient. Secondary outcomes included the maximum sensory block level, motor block degree in the leg, and occurrence of hypotension and pruritus. The truncated Dixon‑Mood method and the Isotonic regression analysis method were used to estimate 90% practical volume (EV90) and 95% confidence intervals (CI). Results The set PIEB volume provided effective analgesia for 32 parturients. According to the effective analgesia results of each parturient, the EV90 was 10.53 ml (95%CI 9.18, 11.87 ml) and 10.76 ml (95%CI 10.30, 11.82 ml), using the truncated Dixon‑Mood method and Isotonic regression analysis, respectively. A total of 3 parturients presented with sensory block levels above T6 in groups 11 ml (n=1) and 12 ml (n=2). However, none of the parturients presented with sensory block levels above T6 in groups 10 ml, 9 ml, and 8 ml, respectively. There were no cases of hypotension and motor block. There is one parturient complained of pruritus in groups 10 ml and 12 ml, respectively. Conclusion With a fixed 45 min PIEB interval, the EV90 with ropivacaine 0.08% and sufentanil 0.3 mg/L should not be less than 10 ml.

Key words: Biased coin up‑and‑down; Epidural labor analgesia; Programmed intermittent epidural bolus; First stage of labor