Ngan Kee W D, Shen J, Chiu A T, Lok I, Khaw K S
Department of Anaesthesia and Intensive Care, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong.
Anaesth Intensive Care. 1999 Oct;27(5):523-6. doi: 10.1177/0310057X9902700516.
We report the use of combined spinal-epidural analgesia during labour in three parturients with moderately severe mitral stenosis. In each case, rapid analgesia was achieved using intrathecal fentanyl 25 micrograms without major haemodynamic changes. Maintenance analgesia was then established gradually using a dilute epidural infusion of bupivacaine 0.1% and fentanyl 0.0002%, with the avoidance of large or rapid boluses of local anaesthetic. Supplementary analgesia in the latter stages of labour was provided using slow epidural boluses of fentanyl, with or without a low concentration of bupivacaine, which was sufficient to allow controlled instrumental deliveries. We conclude that combined spinal-epidural analgesia is a useful technique for providing analgesia and maintaining haemodynamic stability in parturients with mitral stenosis.
我们报告了在三名患有中度严重二尖瓣狭窄的产妇分娩期间使用腰麻-硬膜外联合镇痛的情况。在每例患者中，鞘内注射25微克芬太尼实现了快速镇痛，且未出现重大血流动力学变化。然后使用0.1%布比卡因和0.0002%芬太尼的稀释硬膜外输注逐渐建立维持镇痛，避免大剂量或快速推注局部麻醉药。在分娩后期，使用芬太尼缓慢硬膜外推注提供补充镇痛，可加用或不加用低浓度布比卡因，这足以进行可控的器械助产。我们得出结论，腰麻-硬膜外联合镇痛是为患有二尖瓣狭窄的产妇提供镇痛并维持血流动力学稳定的一种有用技术。
