右美托咪定复合罗哌卡因在产妇硬膜外分娩镇痛中的效果  

Analgesia effect of dexmedetomidine mixed with ropivacaine for patient-controlled epidural analgesia during delivery

作　　者：杨淑萍 钱夏丽 朱伟[1] 蒋秀红[1] YANG Shuping;QIAN Xiali;ZHU Wei;JIANG Xiuhong(Department of Anesthsiology, the Frist Affiliated Hospital of Nanjing Medical University, Nanjing 210029, China)

机构地区：[1]南京医科大学第一附属医院麻醉科,210029

出　　处：《临床麻醉学杂志》2018年第6期550-553,共4页Journal of Clinical Anesthesiology

基　　金：江苏省卫生计生委面上项目(H201604)

摘　　要：目的评价右美托咪定复合罗哌卡因用于产妇自控硬膜外分娩镇痛的效果以及对产后泌乳和新生儿的影响。方法选择自愿要求分娩镇痛单胎足月妊娠产妇79例,年龄22~36岁,ASAⅠ或Ⅱ级,随机分为3组:0.1%罗哌卡因组(R组,n=26)、0.1%罗哌卡复合2μg/ml芬太尼组(RF组,n=27)和0.1%罗哌卡复合2μg/ml右美托咪定组(RD组,n=26)。记录分娩镇痛前(T_0)、注射负荷量后10min(T_1)、30min(T_2)及宫口开全时(T3)的VAS疼痛评分,并记录注射负荷量后30min的Bromage分级和Ramsay镇静评分。记录新生儿Apgar评分以及恶心、呕吐、皮肤瘙痒等不良反应情况。分别于分娩镇痛前、胎儿娩出时、娩出后2h抽取产妇静脉血离心分离并测定催乳素(PRL)浓度,记录泌乳始动时间。结果与R组比较,T_1—T3时RF和RD组产妇VAS疼痛评分明显降低(P<0.05)。与RF组比较,R组和RD组的嗜睡、瘙痒发生率明显降低(P<0.05)。与R组比较,RF和RD组胎儿娩生后2h时血清PRL浓度明显升高,产后泌乳始动时间明显提前(P<0.05)。三组产妇Bromage分级和Ramsay镇静评分差异无统计学意义。新生儿1min、5min Apgar评分差异无统计学意义。结论右美托咪定2μg/ml复合0.1%罗哌卡因用于硬膜外分娩镇痛时镇痛效果好,产妇满意度高,不良反应发生率低,对新生儿无明显不良影响,可促进催乳素分泌,产后泌乳始动时间提前。Objective To evaluate the application of dexmedetomidine mixed with ropivacaine and its effect on lactation and neonatal for patient-controlled epidural analgesia（PCEA）during delivery.Methods Seventy-nine nulliparous puerperas with a single baby at full term in vertex presentation required for labor analgesia,aged 22-36 years,ASA physical statusⅠ orⅡ,were randomly divided into 3 groups according to the random digital table.The VAS scores before analgesia（T0）,10 min（T1）after the load dose of epidural administration,30 min（T2）after the load dose of epidural administration,and full cervical dilatation（T3）,as well as the modified Bromage degrees and Ramsay sedation scores at T2 were recorded.The neonatal Apgar scores and side effects were recorded.The prolactin was centrifuged and determined by drawing maternal venous before analgesia,after fetal delivery,and 2 hlater.The beginning time of lactation was recorded.Results The VAS scores were higher in group R than those in group RF and RD at T1,T2 and T3（P〈0.05）.Compared with group RF,the incidence of drowsiness and pruritus were lower in groups R and RD（P〈0.05）.Compared with group R,the concentration of prolactin was higher after fetal delivery 2 h,the beginning time of lactation was advanced in groups RD and RF（P〈0.05）.There were no statistics differences about the modified Bromage degrees,Ramsay sedation scores and the Apgar scores at 1 and 5 min after delivery among the groups.Conclusion Epidural dexmedetomidine 2μg/ml significantly optimize the efficacy of 0.1% ropivacaine and with higher satisfaction,less side effects,without adverse neonatal effects,can promote the secretion of prolactin and the beginning time of lactation was advanced when used for patient-controlled epidural analgesia during delivery.

关 键 词：硬膜外分娩镇痛 罗哌卡因 右美托咪定 催乳素 

分 类 号：R714.3[医药卫生—妇产科学]