不同浓度地佐辛静脉泵注在中期引产患者分娩镇痛的效果观察  

To investigate the application of dezocine in anesthesia for patients with induced labor

作　　者：毛慧敏[1] 刘淑香[1] 李国芳[1] 黄今[1] 许陪陪 石英娜 姜海永 陈亮[1] 赵凯 

机构地区：[1]石家庄市第四医院麻醉科,河北石家庄050000

出　　处：《广东医学》2018年第1期27-30,共4页Guangdong Medical Journal

摘　　要：目的比较不同浓度地佐辛静脉泵注在中期引产患者分娩镇痛的效果。方法选择自愿要求分娩镇痛的中期引产患者(ASAⅠ~Ⅱ级)360例,随机分为3组,每组120例。A组镇痛泵:地佐辛0.3 mg/mL+托烷司琼5 mg;B组镇痛泵:地佐辛0.4 mg/mL+托烷司琼5 mg;C组镇痛泵:地佐辛0.5 mg/mL+托烷司琼5 mg;中期引产患者经皮羊膜腔穿刺注射利凡诺引产,规律宫缩,宫口开至2 cm时,静脉注射地佐辛5 mg+托烷司琼5 mg,半小时后接镇痛泵,依照分组持续泵注,以6 mL/h用量静脉泵注、PCA追加剂量为2 mL、锁定时间10 min,以维持患者半睡眠无痛状态。观察并记录镇痛前后产妇血压、心率(HR)、镇痛效果(镇痛前、镇痛后10 min、60 min、分娩时VAS评分)、镇痛时间(min)、总耗药量(mL)、PCA次数、应激反应(皮质醇、E、NE)、不良反应(恶心、呕吐、眩晕)。结果镇痛前后产妇SBP、DBP、HR、SpO_2差异无统计学意义(P>0.05),均在正常范围内;镇痛效果VAS评分,B组、C组低于A组(P<0.05),B组、C组差异无统计学意义(P>0.05)。A组PCA按压次数显著高于B组、C组(P<0.01),整个分娩镇痛过程总耗药量A组显著高于B组、C组(P<0.01)。各时段血浆Cor、E、NE浓度镇痛后较镇痛前下降(P<0.05),同时段组间差异无统计学意义(P>0.05)。在整个镇痛期间3组恶心、呕吐发生率分别为4.1%~5.8%,组间比较差异无统计学意义(P>0.05);而眩晕发生率C组明显高于A组、B组(P<0.05)。A组与B组不良反应差异无统计学意义(P>0.05)。结论地佐辛静脉镇痛可为中期引产患者提供分娩镇痛,3种镇痛配方中0.4 mg/mL地佐辛组镇痛效果满意,可减轻患者应激反应,不良反应小,为最佳配伍处方,更适合临床推广。Objective To comparison the anesthetic effects of different concentrations of dezocine for patients with induced labor. Methods Patients with voluntary induced labor analgesia （ ASA I - II, n = 360 ） were randomly di- vided into 3 groups. Analgesia pump was combination of dezocine of 0. 3 mg/ml plus tropisetron of 5 mg in Group A; dezocine of 0. 4 mg/ml plus tropisetron of 5 mg in Group B ; and dezocine of 0. 5 mg/ml plus tropisetron of 5 mg in Group C. When patients had regular uterine contraction, with uterine cervical diameter of 2 cm, intravenous injection with dezo- cine of 5 mg plus tropisetron of 5 mg were given. Anesthesia pump was given half an hour after that. The blood pressures and heart rates before and after the analgesia, analgesic effect （ VAS scores before the analgesia, 10 min and 60 rain after analgesia, and at childbirth）, stress response （cortisol, E, NE）, and side effects （dizziness, nausea and vomiting） were recorded. Results There was no significant difference in maternal blood pressures, heart rate or Sp02 between before and after anesthesia （P 〉0. 05）. The VAS score was significantly lower in Group B and C than Group A （P 〈0. 01 ）, while there was no significant difference between Group B and C （ P 〉 0. 05 ）. No significant difference in plasma concentration of E and NE among the 3 groups was revealed. Conclusion Dezocine can be applied for patients with induced labor. Dezocine of 0.4 mg/ml provides satisfied anesthesia and reduces adverse reaction.

关 键 词：地佐辛 分娩镇痛 中期引产 

分 类 号：R714.3[医药卫生—妇产科学]