Nielsen P E, Erickson J R, Abouleish E I, Perriatt S, Sheppard C
Department of Obstetrics, Gynecology and Reproductive Sciences (Division of Maternal Fetal Medicine, University of Texas Health Science Center, Houston 77030, USA.
Anesth Analg. 1996 Oct;83(4):742-6. doi: 10.1097/00000539-199610000-00014.
The objective of this study was to compare the incidence of intrapartum fetal heart tracing (FHT) abnormalities and the obstetric outcome after intrathecal sufentanil (ITS) versus epidural bupivacaine (EB). During the period from April to September 1994, 129 patients who met inclusion criteria were prospectively identified during labor at a single university-affiliated hospital. Inclusion criteria included: singleton, gestational age > or = 36 wk, and cephalic presentation. In the ITS group, epidural anesthesia was not administered before 60 min after ITS. Sixty-five consecutive ITS patients were compared to 64 consecutive EB patients. Each FHT was reviewed independently by two obstetricians blinded to the type of analgesia. The FHT characteristics evaluated included baseline rate, variability, and periodic changes. No differences in the incidence of clinically significant FHT abnormalities (recurrent late decelerations and/or bradycardia) were observed between the two groups (ITS 21.5% versus EB 23.4%). The rates of clinically significant FHT abnormalities in both groups was not different when patients with hypotension and medical complications were excluded (16.9% vs 17.1%). In addition, equal rates of hypotension (18.5% vs 17.2%) were noted between the groups. In both groups there was a significantly higher risk of cesarean section in patients whose previously normal FHT became abnormal postanalgesia when compared to patients without a new onset FHT abnormality (ITS 28.6% [4/14] versus 2.0% [1/51], P < 0.01; EB 33.3% [5/15] versus 8.2% [4/49], P < 0.05). This increased risk was associated with an increase in cesarean section for nonreassuring FHT in both groups (ITS 14.3% [2/14] versus 0% [0/51], P = 0.04; EB 13.3% [2/15] versus 0% [0/49], P = 0.05). These results support the conclusion that the incidence of clinically significant FHT abnormalities and hypotension is equivalent in patients receiving ITS when compared to EB within the first hour of administration. During this period, patients should have continuous FHT monitoring since a new onset FHT abnormality unveils and alerts the physicians to a possible compromised fetal condition and a corresponding increased risk of cesarean section.
本研究的目的是比较鞘内注射舒芬太尼（ITS）与硬膜外注射布比卡因（EB）后产时胎儿心率监测（FHT）异常的发生率及产科结局。在1994年4月至9月期间，在一家大学附属医院对129名符合纳入标准的产妇进行了前瞻性研究。纳入标准包括：单胎、孕周≥36周且头先露。在ITS组，ITS注射后60分钟内不给予硬膜外麻醉。将连续65例ITS产妇与连续64例EB产妇进行比较。由两名对镇痛类型不知情的产科医生独立审查每次FHT。评估的FHT特征包括基线率、变异性和周期性变化。两组之间临床显著FHT异常（反复晚期减速和/或心动过缓）的发生率无差异（ITS组为21.5%，EB组为23.4%）。排除低血压和内科并发症患者后，两组临床显著FHT异常的发生率无差异（16.9%对17.1%）。此外，两组低血压发生率相当（18.5%对17.2%）。与FHT无新发异常的患者相比，两组中FHT先前正常但镇痛后变为异常的患者剖宫产风险均显著更高（ITS组为28.6%[4/14]对2.0%[1/51]，P<0.01；EB组为33.3%[5/15]对8.2%[4/49]，P<0.05）。这种风险增加与两组因FHT不令人放心而行剖宫产的增加有关（ITS组为14.3%[2/14]对0%[0/
