Kelly M C, Carabine U A, Hill D A, Mirakhur R K
Department of Anaesthetics, Queen's University of Belfast, Northern Ireland.
Anesth Analg. 1997 Oct;85(4):834-8. doi: 10.1097/00000539-199710000-00022.
We studied gastric emptying, using acetaminophen absorption, in 105 women in labor divided into three equal groups of 35 each, after intrathecal (i.t.) (25 micrograms, Group S) or extradural (50 micrograms, Group E) fentanyl in combination with bupivacaine and compared with a control group (Group C) receiving extradural bupivacaine only. The time to maximal acetaminophen concentration (tCamax), maximal acetaminophen concentration (Camax), and areas under the acetaminophen concentration-time curve at 90 and 120 min (AUC90 and AUC120, respectively) were determined. Median (range) tCamax values were 120 (15-180), 82.5 (15-180), and 90 (15-180) min in Groups S, E, and C, respectively (P < 0.05). Mean +/- SD Camax was 13.4 +/- 8.82, 17.9 +/- 8.06, and 15.0 +/- 6.22 micrograms/mL in Groups S, E, and C, respectively (P < 0.05). Mean +/- SD AUC90 and AUC120 were also significantly smaller in Group S than in the other two groups (430 +/- 616, 736 +/- 504, and 672 +/- 453; and 649 +/- 592, 1063 +/- 627, and 1053 +/- 616 micrograms.mL-1.min-1 in Groups S, E, and C, respectively). We conclude that the administration of fentanyl 25 micrograms i.t. delays gastric emptying in labor compared with both extradural fentanyl 50 micrograms with bupivacaine and extradural bupivacaine alone.
We examined emptying of the stomach in women in labor after administration of analgesics by the spinal or the epidural route. We observed that the analgesic, fentanyl, administered by the spinal route, although relieving pain rapidly, may delay emptying of the stomach. In theory, delayed gastric emptying may increase the chance of vomiting and aspiration of gastric contents.
我们采用对乙酰氨基酚吸收法，对105名分娩期妇女进行了胃排空研究。这些妇女被平均分为三组，每组35人。其中一组（S组）经鞘内注射（i.t.）25微克芬太尼，另一组（E组）经硬膜外注射50微克芬太尼并联合布比卡因，还有一组为对照组（C组），仅接受硬膜外布比卡因。测定了达到对乙酰氨基酚最大浓度的时间（tCamax）、对乙酰氨基酚最大浓度（Camax）以及90分钟和120分钟时对乙酰氨基酚浓度 - 时间曲线下的面积（分别为AUC90和AUC120）。S组、E组和C组的tCamax中位数（范围）分别为120（15 - 180）、82.5（15 - 180）和90（15 - 180）分钟（P < 0.05）。S组、E组和C组的平均±标准差Camax分别为13.4 ± 8.82、17.9 ± 8.06和15.0 ± 6.22微克/毫升（P < 0.05）。S组的平均±标准差AUC90和AUC120也显著低于其他两组（S组、E组和C组分别为430 ± 616、736 ± 504和672 ± 453；以及649 ± 592、1063 ± 627和1053 ± 616微克·毫升⁻¹·分钟⁻¹）。我们得出结论，与硬膜外注射50微克芬太尼联合布比卡因以及单独硬膜外注射布比卡因相比，鞘内注射25微克芬太尼会延迟分娩期妇女的胃排空。
我们研究了经脊髓或硬膜外途径给予镇痛药后分娩期妇女的胃排空情况。我们观察到，经脊髓途径给予的镇痛药芬太尼，虽然能迅速缓解疼痛，但可能会延迟胃排空。从理论上讲，胃排空延迟可能会增加呕吐和胃内容物误吸的几率。
