罗哌卡因联合舒芬太尼用于分娩镇痛的临床研究

目的观察低浓度罗哌卡因与小剂量舒芬太尼在硬膜外自控镇痛（PCEA）用于分娩镇痛的效果及母婴的影响。方法选择120例ASAⅠ～Ⅱ,头位,单胎,足月初产,取L2-3锥间隙穿刺。随机分为两组。A组：注入0.125%罗哌卡因与0.2μg.mL-1舒芬太尼,B组：注入0.125%罗哌卡因。记录两组产妇疼痛情况,产程,分娩方式,新生儿Apgar评分,出血量等项目。结果 A组镇痛效果明显优于B组（P〈0.05）,而新生儿Apgar评分,产程,分娩方式,出血量无显著性差别（P〉0.05）。结论 0.125%罗哌卡因与0.2μg.mL-1舒芬太尼硬膜外自控镇痛用于分娩镇痛效果确切,对母婴无不良影响。     

罗哌卡因与不同浓度舒芬太尼联用对硬膜外麻醉产妇分娩时镇痛作用的影响

目的:评价罗哌卡因与不同浓度舒芬太尼联用对硬膜外麻醉产妇分娩时镇痛作用的影响。方法:选取2015年6月—2017年1月期间分娩时硬膜外麻醉镇痛产妇98例资料,将其随机分为Ⅰ组33例、Ⅱ组32例和Ⅲ组33例;Ⅰ组产妇给予0.1%罗哌卡因与0.2μg/mL舒芬太尼联用分娩镇痛,Ⅱ组产妇给予0.1%罗哌卡因与0.4μg/mL舒芬太尼联用分娩镇痛,Ⅲ组产妇给予0.1%罗哌卡因与0.6μg/mL舒芬太尼联用分娩镇痛,比较Ⅲ组产妇分娩时镇痛效果,即疼痛缓解时间、患者自控镇痛(patient controlled analgesia,简称PCA)给药频率以及麻醉平面运动阻滞(Bromage)的评分值和PCA用量和疼痛疼痛视觉模拟(visual analogue scale/score,简称VAS)评分值的差异,以及患者对镇痛效果的满意度评分值的差异。结果:Ⅰ组产妇麻醉后疼痛缓解时间、PCA给药频率、PCA用量及疼痛VAS评分值均大于Ⅱ组、Ⅲ组(P<0.05);Ⅰ组产妇对镇痛满意度的评分值低于Ⅱ组、Ⅲ组(P<0.05)。结论:采用罗哌卡因与不同剂量(0.4μg/mL、0.6μg/mL)舒芬太尼对硬膜外麻醉分娩产妇的镇痛效果优于其与0.2μg/mL舒芬太尼镇痛效果,且疼痛缓解快,PCA给药频率和用量低,且患者对镇痛效果的满意度较高。     

盐酸罗哌卡因-舒芬太尼硬膜外和腰硬联合阻滞分娩镇痛的效果及安全性比较

目的比较盐酸罗哌卡因-舒芬太尼硬膜外和腰硬联合阻滞分娩镇痛的效果及安全性。方法选择ASAⅠ～Ⅱ级,足月,单胎,头位,并自愿要求行分娩镇痛的产妇60例,随机分为CEA组与CSEA组,选择同期无分娩镇痛产妇30例为对照组(C组)。CEA组以2%利多卡因为实验量,随后注入0.1%盐酸罗哌卡因+0.5μg/mL舒芬太尼10mL;CSEA组蛛网膜下腔给予舒芬太尼5μg。两组均采用0.08%盐酸罗哌卡因+0.4μg/mL舒芬太尼硬膜外PCA。记录疼痛评分,下肢肌力,产妇满意度,产程,新生儿Apart评分,产妇生命体征及不良反应。结果 3组下肢肌力、新生儿Apart评分、产妇生命体征比较,差异无统计学意义(P>0.05);与C组相比,CEA组与CSEA组VAS评分显著降低,第一产程缩短,差异有统计学意义(P<0.05);与CEA相比,CSEA组镇痛起效更快,产妇满意度更高(P<0.05)。结论盐酸罗哌卡因-舒芬太尼用于CEA和CSEA均能提供满意且安全的镇痛,CSEA因起效快,产妇满意度高更适合分娩镇痛。     

舒芬太尼与罗哌卡因及其复合液用于分娩镇痛的临床观察

目的 观察蛛网膜下腔注射舒芬太尼与罗哌卡冈及舒芬太尼复合罗哌卡因在腰硬联合阻滞分娩镇痛的效果.方法 选择初产妇60例,随机分3组,3ug舒芬太尼组(S3组)与3mg罗哌卡因组(R3组)及3ug舒芬太尼复合3mg罗哌卡因组(S3R3组),双盲对照观察.各组均采用蛛网膜下腔给药后硬膜外腔留管,产妇自控镇痛(CSE+PCA),且各组的硬膜外维持用药相同.观察记录镇痛起效时间、不同时间的VAS评分、镇痛维持时间、运动阻滞、各组产程、出血量、新生儿lmin和5min Apgar评分、镇痛满意度、剖宫产率、副作用等指标.结果 镇痛起效时间舒芬太尼复合罗哌卡因组小于舒芬太尼组与罗哌卡因组(P<0.05);舒芬太尼复合罗哌卡因组在各时间点的镇痛效果和镇痛满意度均优于舒芬太尼组与罗哌卡因组,且镇痛维持时间明显长于舒芬太尼组与罗哌卡因组(P<0.05).结论 3ug舒芬太尼复合3mg罗哌卡因蛛网膜下腔给药町提供安全、有效的分娩镇痛效果.     

罗哌卡因复合舒芬太尼硬膜外麻醉分娩镇痛临床观察

目的观察甲磺酸罗哌卡因复合舒芬太尼硬膜外麻醉分娩镇痛的效果及对产程的影响。方法 2008年5月—2009年10月在我院住院的产妇,选择自愿接受分娩镇痛的产妇随机抽取100例为镇痛组,另设100例基本情况相似的未实施分娩镇痛的产妇作为对照组,对进入潜伏期疼痛难忍的产妇实施硬膜外穿刺,成功后置入硬膜外导管,硬膜外首次推注1%的甲磺酸罗哌卡因10m l含舒芬太尼5μg的混合液,以后根据疼痛程度间断推入。结果甲磺酸罗哌卡因复合舒芬太尼硬膜外麻醉分娩镇痛的有效率为100%,可有效缩短产程,降低胎儿窘迫及剖腹产率。结论甲磺酸罗哌卡因复合舒芬太尼硬膜外麻醉分娩镇痛临床效果可靠,不影响产程,成本较低,适合基层医院推广使用。     

低浓度罗哌卡因、舒芬太尼分娩镇痛的临床研究

目的比较低浓度罗哌卡因伍用舒芬太尼和芬太尼用于分娩镇痛效果。方法选择ASAⅠ～Ⅱ级,足月单胎初产妇,宫缩正常,无致难产因素及椎管内麻醉禁忌,自愿接受分娩镇痛的产妇100例,随机分为舒芬太尼组（S组）和芬太尼组（F组）,均施行硬膜外自控镇痛。镇痛用药：S组用0.15%罗哌卡因＋0.5μg/ml舒芬太尼混合液;F组用0.15%罗哌卡因＋2μg/ml芬太尼混合液。江苏爱普DDB-Ⅰ型微量泵输入首剂8～12ml,持续量6ml/h,PCA（自控给药）量为3ml,锁定时间20min。观察镇痛效果、运动阻滞效果、产程、新生儿评分、产妇体征、镇痛副作用。结果S组镇痛效果优于F组（P〈0.05）;运动阻滞效果、产程、新生儿评分、产妇体征对比无显著差异;S组镇痛副作用少于F组。结论两种方法用于分娩镇痛都具有良好的临床实用性,相比而言,罗哌卡因舒芬太尼更具优越性。     

不同浓度罗哌卡因复合舒芬太尼用于产妇硬膜外自控镇痛的效果评价

目的探讨不同浓度罗哌卡因复合舒芬太尼用于产妇硬膜外自控镇痛的临床疗效。方法将200例拟行硬膜外自控镇痛分娩的产妇随机分为4组,每组50例。A组产妇给予0.075%罗哌卡因、B组给予0.1%罗哌卡因、C组给予0.125%罗哌卡因、D组给予0.15%罗哌卡因复合舒芬太尼进行硬膜外自控镇痛。比较四组给药后VAS评分、运动阻滞评分及不良反应发生率。结果给药后6、12、24及48 h,B、C及D组VAS评分显著低于A组(P<0.05);D组术后4～24 h运动障碍评分显著高于A、B及C组(P<0.05);四组不良反应发生率差异无统计学意义(P>0.05)。结论 0.1%及0.125%罗哌卡因复合舒芬太尼用于硬膜外自控镇痛分娩临床疗效好,且不增加不良反应。     

盐酸罗哌卡因复合不同剂量舒芬太尼用于硬膜外分娩镇痛的观察

目的探讨0.125%盐酸罗哌卡因复合舒芬太尼用于硬膜外分娩镇痛最适宜的量。方法选择单胎头位初产产妇120例,ASA分级Ⅰ~Ⅱ级,随机分成A、B、C、D四组,于硬膜外注入A组:0.125%盐酸罗哌卡因+舒芬太尼(0.3μg/mL)药液10mL;B组:0.125%盐酸罗哌卡因+舒芬太尼(0.4μg/mL)药液10mL;C组:0.125%盐酸罗哌卡因+舒芬太尼(0.5μg/mL)药液10mL;D组:0.125%盐酸罗哌卡因+舒芬太尼(0.6μg/mL)药液10mL。在疼痛缓解后,接麻醉泵,持续给各组相应局麻药浓度和舒芬太尼剂量的麻醉药6mL/h。记录疼痛明显缓解时间(T),宫缩镇痛评分(VAS评分),下肢运动神经阻滞情况(Bromage),产程时间,分娩方式,新生儿Apgar评分及产妇不良反应。结果四组宫缩镇痛评分(VAS评分)均明显减轻,VAS评分≤6分。C、D两组宫缩镇痛评分(VAS评分)与A组相比,差异明显,(P≤0.05)。C组、D组疼痛明显缓解时间(T)与A组相比明显缩短(P≤0.05),D组下肢运动神经阻滞有6.7%。结论 0.125%盐酸罗哌卡因复合舒芬太尼用于硬膜外分娩镇痛最适宜的量为0.5μg/mL。     

罗哌卡因复合舒芬太尼硬膜外自控镇痛在足月分娩产妇中的应用效果

目的 观察罗哌卡因复合舒芬太尼硬膜外自控镇痛在足月分娩产妇中的应用效果.方法 选取2017年2月—2018年12月湖北科技学院附属浠水医院收治的足月分娩产妇60例,按照随机数字表法分为观察组和对照组,每组30例.对照组产妇常规分娩,观察组给予罗哌卡因复合舒芬太尼硬膜外自控镇痛分娩.比较2组产妇镇痛后30 min、第一产...     

罗哌卡因复合舒芬太尼或芬太尼腰硬联合阻滞用于分娩镇痛的比较

目的 比较在腰麻联合硬膜外PCEA下使用罗哌卡因复合舒芬太尼或芬太尼用于分娩镇痛的效果和对新生儿和产妇的影响。方法 选择ASAⅠ~Ⅱ级,实施分娩镇痛的足月初产妇80例,随机分成两组,S组(腰麻用药为罗哌卡因2 mg+舒芬太尼5 μg,PCEA模式为0.125%罗哌卡因+0.5 mg·L-1舒芬太尼)和F组(腰麻用药为罗哌卡因2 mg+芬太尼20 μg,PCEA模式为0.125%罗哌卡因+2 mg·L-1芬太尼),两组产妇有规律宫缩宫口开大1~2 cm时常规选择L3-4椎间隙行硬膜外穿刺,用25G腰麻穿刺针刺入蛛网膜下腔,回抽脑脊液通畅后给药,腰麻成功后30 min实施PCEA镇痛,背景输注8 mL·h-1,单次PCA剂量6 mL,锁定时间15 min。观察并记录各产程时间和各指标情况,包括各时点VAS疼痛评分、Bromage评分、分娩方式、新生儿出生后1、5和10 min的Apgar评分、缩宫素使用率、产后出血量、产妇满意度、不良反应和呼吸抑制等。结果 宫口开大3、6、10 cm时S组疼痛VAS评分明显低于F组(P<0.05);两组间产程时间和器械助产率差异无统计学意义;两组新生儿出生后1、5、10 min的Apgar评分、两组产妇缩宫素使用率及产后出血量差异均无统计学意义;两组产妇Bromage评分、恶心呕吐、头晕、皮肤瘙痒、呼吸抑制等不良反应发生率差异无统计学意义。结论 腰硬联合阻滞罗哌卡因复合舒芬太尼用于潜伏期分娩镇痛对产妇和胎儿安全,不良反应少。     

瑞芬太尼静脉自控镇痛在分娩中的应用研究

目的 比较瑞芬太尼自控镇痛(PCIA)与罗哌卡因硬膜外自控镇痛(PCEA)在分娩镇痛的镇痛疗效和安全性.方法 40例足月临产妇女随机接受瑞芬太尼PCIA(RA组)或者罗哌卡因PCEA(EA组),RA组瑞芬太尼单次剂量为0.5 μg/kg,锁定时间是2 min,输液速度3 mL/min(60 μg/min),无背景输液.EA组为罗哌卡因1.5 mg/mL+芬太尼2 μg/mL,初始剂量是10 mL/h.视觉模拟评分(VAS)用于疼痛的评估.记录孕产妇心率、血压、血氧饱和度(SpO2)、呼吸速率、镇静、恶心/呕吐、瘙痒、满意度和胎心率,以及新生儿结局,进行比较.结果 这2种方法均提供了良好的镇痛,但RA组镇痛后1h时VAS评分更高,产妇镇静发生率更多,当SpO2＜92％需要吸氧.产妇满意度类似.RA组第一产程、第二产程及总产程较EA组缩短,2组产妇剖宫产率、阴道助产率及新生儿Apgar评分差异无统计学意义(P＞0.05),脐动静脉血气分析未见异常.结论 2组镇痛方法均有效,但镇痛后1 h VAS评分低于EA组,具有高产妇满意度和可靠的新生儿安全性.但要控制剂量,术中严密监测呼吸和循环功能.     

Patient-controlled analgesia

Using a portable infusion pump, intravenous opioid patient-controlled analgesia (PCA) permits a patient to self-deliver a small bolus of opioid to achieve prompt relief without over sedation. Use of PCA for pain management is increasing in hospitals, largely because it can provide equivalent or better analgesia than conventional nurse-administered opioid analgesia, and patients are more satisfied with its use. There is no decisive pharmacological or clinical argument for the choice of one opioid rather than another. Thus, morphine remains the most frequently used opioid in PCA. The adjunction of non-opioid drugs to morphine in the PCA reservoir is still very controversial. A new investigational PCA transdermal system using iontophoresis to deliver fentanyl seems to provide an adequate pain control with the advantages of needle-free, preprogrammed, self-contained device. Whatever drug or device used, the overall success of the PCA technique relies mainly on the expert supervision of nurses or anesthesiologists in an Acute Pain Service. Indeed, PCA is effective and significant only on the condition that there is careful preoperative patient education and strict postoperative monitoring. In addition, preoperative patient selection allows to exclude patients with evidence of cognitive dysfunction or physical disabilities, making the use of the patient-controlled device impossible. Caution is required among patients with respiratory or renal insufficiency. In the future, the indispensable improvement in the management of postoperative pain should lead to a greater expansion of PCA. However, more pharmaco-economic evaluations will be needed on the cost-effectiveness issue.     

剖宫产术中应用联合药物进行切口局部超前镇痛的疗效分析

目的：探讨一种剖宫产术中应用切口局部超前镇痛的效果及对产妇的影响。方法：本院剖宫产术的初产妇200例,随机分为研究组（100例）及对照组（100例）,研究组术中应用联合药物于腹膜、腹直肌腱膜与皮下组织行局部麻醉,对照组采用0.9%氯化钠溶液,观察两组镇痛效果、泌乳情况、并发症及阿片类药物使用情况。结果：研究组在72h后镇痛效果非常明显,与对照组比较差异有统计学意义（P〈0.01）,研究组初次母乳哺乳时间及肛门排气时间明显早于对照组（P〈0.01）,研究组术后应用的阿片药物少于对照组（P〈0.01）。结论：采用局部联合镇痛方法,镇痛效果显著,有利于母乳喂养及产后恢复,且安全、方便,值得推广使用。     

Stress-produced analgesia and morphine-produced analgesia: Lack of cross-tolerance

Animals exposed to cold-water swims, rotation, inescapable shocks, abrupt food deprivation and other stressors display temporary analgesia. Since repeated exposures result in adaptation of this analgesia in much the same way that repeated administration of opiates results in tolerance, the possibility of cross-tolerance between cold-water stress-induced and morphine-induced analgesia was investigated. Flinch-jump thresholds were determined in ten experimental groups of six rats each. Three groups showed dose-dependent analgesia following single injections of morphine at 5, 10 and 15 mg/kg, respectively. A fourth group, subjected to a single cold-water swim at 2°C for 3.5 min, displayed analgesia comparable to that produced by 10 mg/kg of morphine. Groups subjected either to 14 daily cold-water swims or to 14 daily morphine injections at 10 mg/kg showed normal thresholds on the 14th day indicating that adaptation and tolerance had developed, respectively. The cross-over groups were exposed to either 13 days of cold-water swims followed by morphine or the reverse arrangement. Both groups showed profound analgesia instead of cross-tolerance, suggesting that a non-opiate neural mechanism may mediate stress-induced analgesia.     

硬膜外麻醉用于分娩镇痛的临床分析及护理

目的探讨硬膜外麻醉在分娩镇痛中的效果及价值,以寻找一种理想的分娩镇痛方式。方法将2011年7—11月分娩的单胎头位足月临产孕妇100例分为两组,对照组（50例）不进行任何镇痛处理;研究组（50例）进行硬膜外阻滞加硬膜外自控镇痛。对两组患者镇痛效果、产程时间、分娩方式及新生儿Apgar评分进行比较。结果研究组镇痛效果好,与对照组比较,活跃期明显缩短,差异有统计学意义（P〈0.05）;两组第二产程、新生儿Apgar评分比较,差异无统计学意义（P〉0.05）。结论硬膜外麻醉用于分娩镇痛安全、有效,对新生儿的Apgar评分无影响。     

硬膜外氯胺酮超前镇痛对术后镇痛的影响

目的观察切皮前应用氯胺酮在硬膜外腔中的超前镇痛作用对术后镇痛的影响。方法选择40例择期产科手术病人,随机分为两组,每组20人,氯胺酮组在手术开始前于硬膜外腔注入氯胺酮30mg,对照组注入生理盐水。两组均行PCEA吗啡镇痛。记录疼痛出现时间,术后4、8、12、16、24小时VAS评分,24小时镇痛药液消耗量及不良反应。结果氯胺酮组术后疼痛出现时间明显延长(P<0.05);术后16小时及24小时两组VAS评分有统计学意义(P<0.05);两组24小时内吗啡消耗量有统计学意义(P<0.05);两组不良反应无明显差异。结论切皮前硬膜外腔应用氯胺酮具有超前镇痛作用,可加强吗啡术后镇痛的效果。     

Epidural analgesia.

The process of nociception, the anatomy of the epidural space, and the placement of the epidural catheter are reviewed, and the pharmacology and pharmacokinetics, analgesic efficacy, and potential adverse effects of epidurally administered narcotics and local anesthetics are discussed, as well as patient monitoring standards and solution preparation guidelines for these agents. The epidural space is located between the dura mater (the outer-most membrane surrounding the spinal cord) and the vertebral canal. The site of catheter placement is determined by the dermatomes corresponding to the site of desired analgesia. The primary factors that differentiate epidural narcotics are related to their pharmacokinetic profiles. Morphine, which is hydrophilic, has a slower onset of action and a longer duration of analgesia than lipophilic compounds such as fentanyl; morphine also results in less segmentalization (the degree to which analgesia is limited to discrete dermatomal segments corresponding to the level of the epidural narcotic injection) than is seen with lipophilic compounds. Studies have shown that epidural narcotics provide superior pain relief compared with systemic narcotics. Common adverse effects associated with therapeutic doses of intraspinal narcotics include itching, nausea and vomiting, urinary retention, and sedation; respiratory depression is uncommon after epidural administration of narcotics. The most bothersome adverse effect encountered with analgesic doses of local anesthetics is paresthesia. Solutions for epidural administration must be sterile and preservative free. Epidural administration of narcotics and local anesthetics seems to provide better pain relief than conventional methods but may be associated with more bothersome adverse effects.