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目的 评价硬膜外芬太尼对母婴的安全性。方法 随机选择 90例进入活跃期单胎初产妇 ,均采用腰麻硬膜外联合镇痛 (CSEA)和硬膜外患者自控镇痛 (PCEA)的分娩镇痛技术 ,蛛网膜下腔注射 2 g/L罗哌卡因3mg后 30min ,随机分为三组行自控镇痛观察。用放射性免疫分析法 (RIA)于宫口开全时测定母体血浆和新生儿出生即刻脐静脉血中芬太尼的血药浓度。结果 A组罗哌卡因用药量和PCA次数显著多于B组及C组 (P <0 .0 5 ) ,C组 2例 (2 5 % )、B组 3例 (37.5 % )母体血浆芬太尼含量为 (0 .0 2 72± 0 .0 2 6 )ng/ml;B组 2例 (2 5 % )脐静脉血中测定出芬太尼 ,1例为 0 .0 0 0 5ng/ml,另 1例为 0 .0 0 7ng/ml。新生儿Apgar评分、产程及镇痛时间、宫缩及运动神经阻滞情况组间无显著性差异 (P >0 .0 5 )。结论 硬膜外罗哌卡因伍用 2 μg/ml芬太尼 ,芬太尼通过胎盘微乎其微 ,对胎儿无呼吸抑制
Objective To evaluate the safety of epidural fentanyl for mothers and infants. Methods A total of 90 preterm infants were enrolled in this study. All of them were given labor analgesia with spinal anesthesia combined with epidural analgesia (CSEA) and epidural analgesia (PCEA). Subarachnoid injection of 2 g / L ropivacaine 3mg after 30min, were randomly divided into three groups of controlled analgesia. Radioimmunoassay (RIA) was used to determine the plasma concentration of fentanyl in maternal plasma and neonatal umbilical vein blood at the time of uterine opening. Results The dosage of ropivacaine and the number of PCA in group A were significantly higher than those in group B and C (P <0.05), in group C (2 5%) and group B in 3 (37.5%). Fentanyl was detected in 2 cases (25%) of group B in group B. One case was fentanyl (0.0002ng / ml) ml, the other one was 0. 0 0 7ng / ml. Neonatal Apgar score, labor process and analgesia time, contractions and motor block were not significantly different between groups (P> 0.05). Conclusion Epidural ropivacaine with 2 μg / ml fentanyl, fentanyl through the placenta is minimal, no respiratory depression on the fetus