患者自控硬膜外镇痛：硬膜外注射芬太尼在产时产后尿潴留中的作用

Patient-controlled epidural analgesia: the role of epidural fentanyl in peripartum urinary retention.

作者信息

Evron S, Muzikant G, Rigini N, Khazin V, Sessler D I, Sadan O, Ezri T

机构信息

Obstetric Anesthesia Unit, Department of Anesthesia and Department of Obstetrics and Gynecology, The Edith Wolfson Medical Center, Holon.

出版信息

Int J Obstet Anesth. 2006 Jul;15(3):206-11. doi: 10.1016/j.ijoa.2005.10.019.

DOI:10.1016/j.ijoa.2005.10.019

PMID:16798445

Abstract

BACKGROUND

Urinary bladder function is impaired during labor and delivery, predisposing to urinary retention. The effect of low-dose epidural opioid on bladder function remains unclear. We tested the hypothesis that adding low-dose fentanyl to epidural ropivacaine for patient-controlled labor analgesia does not promote urinary retention.

METHODS

Laboring women who requested patient-controlled epidural analgesia were randomly assigned in a double blind study to 0.2% ropivacaine (R-group, n=100) or 0.2% ropivacaine with fentanyl 2 microg/mL (RF-group, n=98). Urinary bladder distension was assessed clinically every hour. The post-void residual urine volume was measured by ultrasonography. Urine volume exceeding 100 mL was drained by catheterization. Bladder volume of > or =300 mL, as determined by catheterization was considered as evidence of urinary retention.

RESULTS

Thirty percent of the patients in each group developed urinary retention during labor. There was no statistically significant difference between the groups. There was an excellent correlation between bladder volume as estimated by ultrasonography and that by catheterization: catheterization volume=0.93 x ultrasound volume + 25; r(2)=0.83. The bias (mean error) was -1+/-99 mL and the precision (average absolute error) between the ultrasound estimate and actual bladder volume determined by catheterization was 58+/-79 mL.

CONCLUSION

Addition of fentanyl to patient-controlled epidural analgesia did not increase the risk of urinary retention. Ultrasound measurements were effective and reliable in assessing urinary bladder volumes during labor.

摘要

背景

分娩过程中膀胱功能受损，易导致尿潴留。低剂量硬膜外阿片类药物对膀胱功能的影响尚不清楚。我们检验了以下假设：在硬膜外罗哌卡因用于患者自控分娩镇痛时添加低剂量芬太尼不会促进尿潴留。

方法

在一项双盲研究中，将要求进行患者自控硬膜外镇痛的产妇随机分为两组，一组接受0.2%罗哌卡因（R组，n = 100），另一组接受含2μg/mL芬太尼的0.2%罗哌卡因（RF组，n = 98）。每小时临床评估膀胱扩张情况。通过超声测量排尿后残余尿量。残余尿量超过100 mL时通过导尿排出。通过导尿确定膀胱容量≥300 mL被视为尿潴留的证据。

结果

每组中30% 的患者在分娩期间出现尿潴留。两组之间无统计学显著差异。超声估计的膀胱容量与导尿测量的膀胱容量之间具有良好的相关性：导尿容量 = 0.93×超声容量 + 25；r² = 0.83。偏差（平均误差）为 -1±99 mL，超声估计值与导尿确定的实际膀胱容量之间的精密度（平均绝对误差）为58±79 mL。