不同剂量的右美托咪定在剖宫产术后硬膜外镇痛的应用  

Different doses of dexmedetomidine in the application of epidural analgesia after caesarean section

作　　者：赵侠勇 王晓娟 刘燕[1] 薛荣亮[1] 董小章[1] 张惠[1] 吴刚[1] 

机构地区：[1]西安交通大学第二附属医院麻醉科,710004 [2]陕西省安康市中心医院麻醉科 [3]渭南市妇幼保健院

出　　处：《国际麻醉学与复苏杂志》2014年第5期397-400,418,共5页International Journal of Anesthesiology and Resuscitation

基　　金：国家临床重点专科建设项目资助（卫办医政函[2011]873号）

摘　　要：目的观察不同剂量的右美托咪定（dexmedetomidine，Dex）与罗哌卡因、芬太尼用于剖宫产术后自控硬膜外镇痛（patient controll edepidural analgesia，PCEA）的效果、应激反应及安全性。方法将80例美国麻醉医师协会（ASA）分级I～Ⅱ级行剖宫产术后镇痛的患者，根据Dex不同剂量采用随机数字表法随机分为4组（每组20例）：A组（0）、B组（0．5mg／L）、C组（0．8mg／L）、D组（1．5mg／L），A组为对照组，其余组为实验组；4组分别联合罗哌卡因（1．5g／L）与芬太／E（2mg／L）行PCEA。记录术后各时点6、12、24、48h的镇痛视觉模拟（visual analogue scale，VAS）评分、用药量、总按压次数、有效按压次数、平均动脉压、心率、感觉、运动阻滞程度（Bromage评分）、镇静程度（Ramsay评分）及副作用（恶心、呕吐、皮肤瘙痒、术后寒战等）。记录术前及术后各时点6、12、24、48h的皮质醇（cortisol，Cor）和血糖（bloodglucose，Glu）数值。结果B、c、D组VAS评分住各时间点均明显低于对照组（A组）（P〈0．05），其中术后12h时B、C组静态VAS分值[（1．7±0．9），（1．6±0．6）]、动态VAS分值[（3．3±0．7），（3．4±0．5）]比较差异有统计学意义，而B组和c组差异无统计学意义（P〉0．05）。各组各时点Cor和Glu指标：B、C两组术后12hcor[（26．3±7．6）、（26．2±8.3）mg／L]和术后6hG1u[（6．4±2．4）、（6．2±2．4）mmol／L]与A组比较，差异有统计学意义（P〈0．05）。48h时总用药量、总按压次数、有效按压次数，A组明显高于其他组（P〈0．05）。另外4组平均血压、双下肢运动未见明显异常，对照组A副作用率明显高于其他组。但D组有4例患者局部皮肤麻木感，有1例患者嗜睡，有1例患者出现心动过缓。结论Dex辅助用于剖宫产术后硬膜外镇痛时，明显增加了术后镇痛效果，减轻了机体应激反应�Objective To observe the effects, stress response and safety of different doses of dexmedetomidine （Dex） on epidural analgesia after caesarean section. Methods According to different doses of the Dex, 80 cesarean section patients with ASA I -II were averagely divided into four groups by random number table method： A（0）, B（0.5 rag/L）, C（0.8 rag/L）, D（ 1.5 mg/L）, with A being the control group. Every group was separately combined with 0.15% ropivacaine and fentanyl （2 mg/L） tor patient controlled epidural analgesia（ PCEA ）. The visual analogue scale （VAS）, drug consumption, total press numbers, effective press numbers, mean arterial pressure, heart rate, sensation, Motor block level（Bromage score）, Sedation degree（Ramsay score） at 6, 12, 24, 48 h after caesarean section and the side effect（nausea and vomiting and pruritis, shiver etc） were recorded. The date of the cortisol（Cor） and blood glucose （Glu） at preoperative and 6, 12, 24, 48 h after caesarean section was also recorded. Results B,C,D groups showed lower score than A group in visual analogue scale（P〈0.05） and the difference between static VAS score[ （1.7±0.9）, （1.6±0.6）] and dynamic VAS score[ （3.3±0.7）, （3.4±0.5） ] of B and C groups had remarkable statistical significance 12 h postoperatively, but there were no significance between B and C groups （P〉0.05）. At 6,12 h Cor and Glu postoperatively there was an evident statistical significance （P〈0.05） between B,C groups and A group. Compared with 48 h drug consumption, total press numbers, effective press numbers, A group is significantly higher than other groups （P〈0.05）, while B group and C group had no statistical significance （P〉0. 05）. Besides, There were no obvious abnormal in the average blood pressure and the motion function of both lower extremities. Moreover, adverse reaction rate of A group is significantly higher than other groups. In D group, 4 cases suffered from local skin numbness, 1 case le

关 键 词：右美托咪定 剖宫产 术后自控硬膜外镇痛 

分 类 号：R614[医药卫生—麻醉学]