【摘要】 目的采用序贯法分析剖宫产病人腰-硬联合麻醉中联合应用芬太尼对罗哌卡因半数有效剂量(ED50)的影响。方法选择大邑县人民医院择期拟行剖宫产术的足月单胎初产妇100例作为研究对象,采用抽签法法将产妇随机分为0.5%罗哌卡因组(R组,n=50)和0.5%罗哌卡因联合10μg芬太尼组(RF组,n=50)。R组和RF组0.5%罗哌卡因的初始剂量分别为15 mg和8 mg,根据阻滞效果按照Dixon序贯法确定下一例产妇的剂量,剂量调整间隔为0.5 mg。采用Probit概率单位回归法计算两组产妇ED50及其95%置信区间(95%CI)。结果 RF组ED50为6.370 mg(95%CI:5.892~11.477 mg),R组ED50为14.088 mg(95%CI:13.412~20.893 mg),与R组比较,RF组产妇的0.5%罗哌卡因半数有效剂量更低,感觉阻滞起效早,运动阻滞程度低,差异有统计学意义(P<0.05)。结论剖宫产患者腰-硬联合麻醉中联合应用芬太尼可以有效降低罗哌卡因半数有效剂量(ED50),可以保证满意的麻醉效果前提下减少罗哌卡因的用药,缩短麻醉的起效时间,降低麻醉并发症的发生风险,值得在临床推广应用。更多还原

【Abstract】 Objective To explore the effect of adding 10μg fentanyl on 50% effective dose of ropivacaine during spinal-epidural anesthesia in cesarean section.Methods One hundred cases of full term primiparas undergoing selective cesarean section under combined spinal-epidural anesthesia in our hospital were selected as research subjects.The parturients were randomly divided into ropivacaine group( group R,n = 50) and ropivacaine combined fentanyl group( group RF,n = 50).The initial doses were 15 mg for the R group,and 8 mg for the RF group.The dose was increased or decreased by 0. 5 mg in next parturient using an up-and-down sequential allocation technique.The ED50 and 95% confidence interval( CI) were calculated by Probit Regression Model. Results The ED50 of0. 5% ropivacaine used for caesarean section was 14. 088 mg( 95 CI: 13. 412 ~ 20. 893 mg) while with fentanyl,ED50 was 6. 370 mg( 95 CI: 5. 892~11. 477 mg).The ED50 of 0. 5% ropivacaine in the RF group was significantly lower than that of the R group( P<0. 05).The onset time of sensory block in the R group was significantly later than that of the RF group( P< 0. 05) while the degree of motor block in the R group was more than that of the RF group( P< 0. 05). Conclusion The combined use of fentanyl with ropivacaine in caesarean section can effectively reduce the 50% effective dose.It can reduce the use of ropivacaine on the premise of satisfactory anesthesia,shorten the onset time of anesthesia and reduce the risk of complications.It is worthy of clinical application.更多还原