Fernando R, Bonello E, Gill P, Urquhart J, Reynolds F, Morgan B
Department of Anaesthesia, Queen Charlotte's Hospital, London, UK.
Anaesthesia. 1997 Jun;52(6):517-24. doi: 10.1111/j.1365-2044.1997.154-az0160.x.
To investigate current concerns that potent opioid drugs, such as fentanyl, used for labour regional analgesia may affect neonatal status, maternal and umbilical plasma concentrations of fentanyl and bupivacaine at delivery were measured in 40 nulliparous patients receiving low-dose combined spinal epidural analgesia. Neonatal assessments included Apgar scores, umbilical blood gases and neurobehavioural tests. All maternal and umbilical venous plasma concentrations were low. Maternal and umbilical vein total fentanyl concentrations increased with increasing doses of epidural fentanyl (r = 0.46 and 0.30, respectively, p < 0.01). There were no significant differences between maternal and umbilical venous plasma total or free concentrations of fentanyl. Mean umbilical vein/maternal fentanyl ratios were 1.12 for total drug and 1.20 for free drug and values were unrelated to the last epidural bolus to delivery interval (r = 0.12, p = 0.49). There were no correlations between Apgar scores, umbilical blood gases or neurobehavioural scores and umbilical venous concentrations of either fentanyl or bupivacaine. The dose of fentanyl used for ambulatory combined spinal epidural analgesia would appear to have a negligible effect on neonatal condition.
为研究当前人们所关注的用于分娩区域镇痛的强效阿片类药物（如芬太尼）可能会影响新生儿状况这一问题，对40例接受低剂量腰麻 - 硬膜外联合镇痛的初产妇在分娩时的芬太尼和布比卡因母体及脐血血浆浓度进行了测定。新生儿评估包括阿氏评分、脐血气分析和神经行为测试。所有母体和脐静脉血浆浓度均较低。母体和脐静脉总芬太尼浓度随硬膜外芬太尼剂量增加而升高（分别为r = 0.46和0.30，p < 0.01）。芬太尼的母体和脐静脉血浆总浓度或游离浓度之间无显著差异。脐静脉/母体芬太尼平均比值，总药物为1.12，游离药物为1.20，且这些值与最后一次硬膜外推注至分娩的间隔时间无关（r = 0.12，p = 0.49）。阿氏评分、脐血气分析或神经行为评分与脐静脉芬太尼或布比卡因浓度之间均无相关性。用于门诊腰麻 - 硬膜外联合镇痛的芬太尼剂量似乎对新生儿状况影响可忽略不计。
