Gaiser R R, McHugh M, Cheek T G, Gutsche B B
Department of Anesthesia, Hospital of the University of Pennsylvania, Philadelphia, PA 19104, USA.
Int J Obstet Anesth. 2005 Jul;14(3):208-11. doi: 10.1016/j.ijoa.2004.12.010.
Intrathecal opioids for labor analgesia are occasionally associated with fetal heart rate abnormalities. We wanted to identify risk factors for this occurrence.
The fetal tracings of 151 consecutive patients were reviewed for the period including 30 min before and 60 min after combined spinal-epidural analgesia using intrathecal bupivacaine with fentanyl. Their progress of labor at injection was also recorded.
Lack of fetal head engagement (odds ratio 5.5, 95% CI 2.1-14.2) and the presence of variable fetal heart rate decelerations (odds ratio 3.6, 95% CI 1.6-8.4) were associated with prolonged fetal heart rate deceleration after combined spinal-epidural analgesia.
This case-control study suggests that if the fetal head is not engaged or if the fetus is experiencing variable decelerations, there is an increased risk of prolonged fetal heart rate deceleration following intrathecal fentanyl/bupivacaine. This finding must now be confirmed in a cohort study.
鞘内注射阿片类药物用于分娩镇痛偶尔会伴有胎儿心率异常。我们想要确定这种情况发生的风险因素。
回顾了151例连续患者在使用鞘内布比卡因加芬太尼进行腰麻-硬膜外联合镇痛前30分钟至镇痛后60分钟期间的胎儿监护情况。同时记录了注射时的产程进展。
胎头未衔接（比值比5.5，95%可信区间2.1-14.2）和存在可变减速（比值比3.6，95%可信区间1.6-8.4）与腰麻-硬膜外联合镇痛后胎儿心率减速延长有关。
这项病例对照研究表明，如果胎头未衔接或胎儿出现可变减速，鞘内注射芬太尼/布比卡因后胎儿心率减速延长的风险会增加。这一发现现在必须在队列研究中得到证实。
