低剂量布比卡因混合吗啡对硬膜外分娩镇痛的影响

目的：观察吗啡和低剂量布比卡因用于硬膜外分娩镇痛对分娩和新生儿的影响以及产妇的副作用。方法：本试验是前瞻性、随机、双盲试验。120例待产妇随机分为两组：硬膜外导管置入后分别给予0.1%布比卡因+2μg/ml芬太尼（BF组）；0.0625%布比卡因+2μg/ml芬太尼+2mg吗啡（BFM组）。所有药物均稀释到15ml，BFM组中吗啡为单次注射。结果：BFM组的布比卡因的总用量小于BF组(P=0.0001)，第二产程时间也较BF组显著减少。BF组在首次给药后镇痛满意度较高（P=0.0001），且15min、30min、45min的视觉评分更低(P=0.0001,P=0.001,P=0.005)。两组产妇的产后镇痛满意度无明显统计学差异。BFM组共记录到6例恶心或呕吐病人。结论：由低浓度局麻药和2mg吗啡组成的硬膜外镇痛方案能提供满意的无痛分娩，没有对母亲或胎儿产生不良影响。该方案无需通过加大局麻药浓度来增加产妇满意度，并且能缩短第二产程。

Effect of low dose of Bupivacaine(BUP) combined with morphine on Epidural labor analgesia

Objective:To observe the effect of morphine and low dose of bupivacaine for epidural labor analgesia on delivery and neonates, and the side-effect on puerperal. Methods:this experiment is prospective, random and dou-ble-blind. 120 expectant mothers were randomly divided into two groups: after epidural catheter placement, 0.1%BUP+2μg/ml Fentanyl were given (BF group);and other group 0.0625%BUP+2μg/mlFentanyl+2mg morphine (BFMgroup). All the drugs were diluted to 15ml, in BFM morphine was given one time only. Results:Total dosage of BUP in BFM group is lower than that of BF group ( P=0.0001), and the delivery time is remarkably shorter than that of BF group. Satisfaction degree after first dosage in BF group is very high (P=0.0001), and the visual scores after 15 min, 30 min and 45 min are much lower ( P=0.0001, P=0.001, and P=0.005). satisfaction rate of Postpartum analgesia of the two groups shows no statistical difference. 6 cases of nausea or vomiting were recorded in BFM group. Conclusion:epidural labor analgesia consisting of low dose of local anesthesia and 2mg morphine can achieve satis-factory painless labor, which causes no unfavorable effects on mothers or infants. This scheme can enhance expectant mothers' satisfaction without addition of local analgesia drug and shorten the second stage of labor.