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    右美托咪定在患者自控硬膜外分娩镇痛中的效果观察

    Effectiveness of dexmedetomidine in patient-controlled epidural analgesia during labor

    • 摘要: 目的 评估右美托咪定联合罗哌卡因在患者分娩时自控硬膜外镇痛(PCEA)的效果。方法 选取足月初产临产妇60例,并随机分为对照组(R组)和研究组(RD组),每组30例。2组产妇均行PCEA,予R组0.125%罗哌卡因10 ml作为首次剂量,并予RD组0.125%罗哌卡因+0.5 mg/L右美托咪定10 ml作为首次剂量; 30 min后通过硬膜外导管连接一次性电子输液泵,PCEA溶液分别采用0.1%罗哌卡因和0.1%罗哌卡因+0.5 mg/L右美托咪定。记录2组产妇分娩镇痛前(T0)、镇痛后10 min(T1)、镇痛后30 min(T2)、镇痛后60 min(T3)、宫口开全时(T4)、胎儿娩出后即刻(T5)时的心率(HR)、平均动脉压(MAP)、脉搏氧饱和度(Sp O2)等生命体征; T0~T5时VAS评分; T2~T5时Ramsay镇静评分和T1~T5时改良Bromage评分。观察产妇麻醉感觉平面,记录PCEA次数和所需镇痛药物的总量。统计各产妇产程时间,新生儿Apgar评分,以及并发症的发生率。结果 与R组相比,RD组产妇在T2和T3时HR显著降低,T3时MAP显著降低,差异有统计学意义(P<0.05)。RD组在T2~T4时Ramsay镇静评分较R组明显升高,差异有统计学意义(P<0.05)。与R组相比,RD组PCEA次数、总用药量明显减少、寒战发生率明显降低,差异有统计学意义(P<0.05)。2组产妇各时间点VAS评分、改良Bromage评分、麻醉感觉平面、各产程时间、新生儿Apgar评分差距以及其他并发症发生率比较,差异无统计学意义(P>0.05)。结论 罗哌卡因与右美托咪定联用可改善产妇分娩时PCEA的镇静效果,减少用药量,减少寒战发生,对产程时间及新生儿无明显影响。

       

      Abstract: Objective To evaluate the effectiveness of dexmedetomidine combined with ropivacaine in patient-controlled epidural analgesia(PCEA) during labor. Methods A total of 60 parturient women were selected and randomly divided into two groups(n = 30): a control group(group R) and a study group(group RD). Both groups underwent epidural labor analgesia,in which group R received 10 ml of 0. 125% ropivacaine and group RD received 10 ml of 0. 125% ropivacaine + 0. 5 mg/L dexmedetomidine as the first dose. After 30 min,a PCEA pump was connected via the epidural catheter,where the PCEA solution was 0. 1% ropivacaine and 0.1% ropivacaine + 0.5 mg/L dexmedetomidine respectively. Then,their heart rate(HR),mean arterial pressure(MAP) and oxygen saturation(Sp O2) was recorded before labor analgesia(T0),10 min after analgesia(T1),30 min after analgesia(T2),60 min after analgesia(T3),at full cervical dilation (T4),and immediately after delivery(T5). The VAS score were evaluated at T0-T5,Ramsay sedation score was recorded at T2-T5,and modified Bromage score was recorded at T1-T5. The level of anesthesia,PCEA dosage and times were observed. The time of labor,Apgar score,and incidence of complications were recorded. Results Compared with group R,group RD presented remarkable decreases in HR at T2 and T3,and in MAP at T3(P < 0. 05). Group RD produced significantly higher Ramsay sedation score than group R(P < 0. 05). Compared with group R,remarkable decreases were found in PCEA dosage and times and the incidence of shiver in group RD(P <0. 05). There was no significant difference in VAS score,modified Bromage score,the level of anesthesia,the time of labor,Apgar score,and the incidence of other complications between the two groups(P > 0. 05). Conclusions The combined use of dexmedetomidine and ropivacaine can improve the sedative effect of PCEA during labor,reduce the dosage and the incidence of shiver,without significant effect on labor time and newborn.

       

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