Alahuhta S, Räsänen J, Jouppila P, Jouppila R, Hollmén A I
Department of Anaesthesiology, University of Oulu, Finland.
Anesthesiology. 1993 Feb;78(2):231-6. doi: 10.1097/00000542-199302000-00004.
The pain of parturition is associated with major physiologic alterations mediated by neurohumoral factors and increased activation of the sympathetic nervous system. Epidural local anesthetics abolish or alleviate many of the pain-mediated responses by reducing maternal catecholamine levels, inducing sympathectomy and consequent vasodilatation. The hormone response to surgical stress is not attenuated after epidural opioids as efficiently as after local anesthetics. Opioid receptors may modulate sympathetic outflow at a spinal level. This study was performed to compare the effects of epidural sufentanil and bupivacaine on the uterine and placental circulation.
Utilizing a prospective randomized, double-blind study design, 30 healthy women at term were examined employing a color Doppler technique to assess and compare the effects of analgesia using sufentanil or bupivacaine epidurally during the first stage of labor on blood flow velocity waveforms in the uterine and umbilical arteries.
Effective analgesia was provided by both drugs, bupivacaine and sufentanil. Uterine and umbilical blood velocity waveform indices did not change significantly. There was, however, a significantly greater incidence of fetuses with changes in heart rate tracings in the sufentanil group, decreased variability being the most frequent. Maternal side effects attributable to sufentanil were common but mild. No patient became hypotensive in either group.
Epidural sufentanil and bupivacaine provide effective analgesia with acceptable side effects during the first stage of labor in healthy parturients. Neither drug had any detrimental effects on blood flow indexes reflecting peripheral vascular resistance in the umbilical and uterine arteries in healthy parturients.
分娩疼痛与神经体液因素介导的主要生理改变以及交感神经系统激活增加有关。硬膜外局部麻醉药通过降低母体儿茶酚胺水平、诱导交感神经切除术及随之而来的血管扩张，消除或减轻许多由疼痛介导的反应。硬膜外使用阿片类药物后，机体对手术应激的激素反应不如使用局部麻醉药后那样有效减弱。阿片受体可能在脊髓水平调节交感神经传出。本研究旨在比较硬膜外舒芬太尼和布比卡因对子宫及胎盘循环的影响。
采用前瞻性随机双盲研究设计，对30名足月健康女性进行检查，运用彩色多普勒技术评估和比较在第一产程中硬膜外使用舒芬太尼或布比卡因镇痛对子宫动脉和脐动脉血流速度波形的影响。
布比卡因和舒芬太尼均提供了有效的镇痛效果。子宫和脐部血流速度波形指标没有显著变化。然而，舒芬太尼组胎儿心率描记变化的发生率显著更高，最常见的是变异性降低。舒芬太尼引起的母体副作用常见但轻微。两组均无患者出现低血压。
硬膜外舒芬太尼和布比卡因在健康产妇第一产程中提供了有效的镇痛效果且副作用可接受。两种药物对反映健康产妇脐动脉和子宫动脉外周血管阻力的血流指标均无任何有害影响。
