微量吗啡Spinocath导管连续腰麻用于分娩镇痛的临床研究

目的观察微量吗啡Spinocath导管连续腰麻用于分娩镇痛的有效性和安全性。方法Spinocath导管连续蛛网膜下腔镇痛组（Ⅰ组）与对照组（Ⅱ组）各15例初产妇,Ⅰ组于宫口开至2～3 cm时,注入吗啡0.1 mg。于第二产程开始时注入吗啡0.05mg＋布比卡因1 mg,均在改平卧位后,调节痛觉上界平面为T_9。观察记录Ⅰ组产妇在给药后30min内呼吸循环变化及两组新生儿出生后Apgar评分、镇痛效果、运动神经阻滞、催产素的使用、产程进展、助产及剖宫产发生率、分娩镇痛的并发症;Ⅱ组为对照组,未做任何镇痛。结果与对照组比较,Spinocath导管连续蛛网膜下腔镇痛组对新生儿出生后Apgar评分、第三产程时间均无明显影响,第一产程、第二产程时间略有延长,但两组比较差异无统计学意义（P〉0.05）。产痛显著减轻（P〈0.05）,对运动神经无影响（P〉0.05）,产后恶心、呕吐发生率增加（P〈0.05）。结论微量吗啡Spino—cath导管连续腰麻用于分娩镇痛起效快,镇痛效果确切,对运动神经无阻滞,对新生儿及产程无明显影响,但其恶心呕吐发生率增加,且费用略显昂贵。

The clinical study of continuous spinal anesthesia with small dose of morphine by Spinocath catheter for labor analgesia

Objective To observe the effect and safety of continuous spinal anesthesia with small dose of morphine by Spinocath catheter for labor analgesia. Method Adopting spinocath subarachnoid catheter method for analgesia group （group Ⅰ） and the controlled group （group Ⅱ） without analgesia, 15 cases of primiparae were chosen respectively. For the group Ⅰ, during the cervix orifice opening to 2 - 3cm, morphine 0. 1mg was injected. At the beginning of the second stage of labor , morphine 0.05 mg and bupivacaine lmg were given. The analgesia plane was regulated at T9. Changes of the breath and heart rates in 30min after administration in group Ⅰ and the Apgar score after birth, analgesic effect, the motor nerve block, the use of oxytocin, process of labor, rate of caesarean birth and diliver , complications of labor analgesia in the two groups were recorded. Results For labor analgesia group, compared with the controlled group, there were no significant influence after the birth of the newborn Apgar score and the time cosumed in the first stage of the labor, a slight delay of the time in the second and the third stage, but the difference was not statistically significant between two groups （P〉 0.05）. In group Ⅰ, pain was significantly reduced （P〈0.05）, and there were no effects on motor function （P〉 0.05）, the incidence of nausia and vomiting after labor increased （P 〈0.05）. Conclusion continuous spinal anesthesia with small dose of morphine by Spinocath catheter for labor analgesia has precisely quick effect, no motor nerve block, and no effect on the newborn and the stage of labor, but the increase of the incidence of nausia and vomiting, andthe cost is slightly expensive.