右美托咪定复合布托啡诺在剖宫产术后镇痛的应用  

Effects and safety of intravenous dexmedetomidine combined with butorphanol for post caesarean section analgesia

作　　者：刘世江[1] 彭培培[1] 蒋秀红[1] 丁正年[1] 刘存明[1] 高梅[1] LIU Shijiang;PENG Peipei;JIANG Xiuhong;DING Zhengnian;LIU Cunming;GAO Mei(Department of Anesthesiology,the First 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9期841-844,共4页Journal of Clinical Anesthesiology

摘　　要：目的研究右美托咪定复合布托啡诺用于剖宫产术产妇自控静脉镇痛(PCIA)的安全性和临床效果。方法选择择期硬膜外麻醉下行剖宫产术产妇60例,年龄24～43岁,身高153～171cm,体重53～93kg,ASAⅠ或Ⅱ级,采用随机数字表法将产妇分为两组(n=30)。对照组(C组):胎儿娩出断脐后静脉给予生理盐水30ml,术后PCIA(布托啡诺3μg·kg^(-1)·h^(-1),背景输注速率2ml/h,每次按压0.5ml,锁定时间10min);右美托咪定组(D组):胎儿娩出断脐后静脉给予右美托咪定0.5μg/kg,术后PCIA(布托啡诺3μg·kg^(-1)·h^(-1)复合右美托咪定0.05μg·kg^(-1)·h^(-1),背景输注速率2ml/h,每次按压0.5ml,锁定时间10min)。记录术后6、12、24和48h安静、运动和宫缩状态下的VAS评分;术后48h内产妇泌乳后取乳汁,采用高效液相色谱质谱联用法(HPLCMS/MS)测定乳汁中右美托咪定浓度并计算相对婴儿摄取量(RID);记录术后产妇满意度以及不良反应的发生情况。结果与C组比较,D组在术后6、12、24h安静、运动和宫缩状态下VAS评分明显降低(P<0.05),D组在术后48h运动VAS评分明显降低(P<0.05);D组产妇满意度明显高于C组(P<0.05);D组右美托咪定RID值为(0.197±0.114)%;两组术后均未发生低血压、低氧血症、呼吸抑制、心动过缓以及恶心和呕吐等不良反应。结论健康产妇围术期使用右美托咪定可安全哺乳。术后镇痛使用布托啡诺复合0.05μg·kg^(-1)·h^(-1)右美托咪定能够提供满意的镇痛效果。Objective To observe the effects and safety of intravenous dexmedetomidine combined with butorphanol for post caesarean section analgesia.Methods Sixty parturients undergoing scheduled caesarean section aged 24-43 years,heighing 153-171 cm,weighing 53-93 kg,ASA physical statusⅠ or Ⅱ,were enrolled and received 0.5μg/kg dexmedetomidine or 0.9% sodium chloride after delivery and cord clamping,followed by butorphanol 3μg·kg^（-1）·h^（-1） only（group C）or combined with dexmedetomidine at 0.05μg·kg^（-1）·h^（-1）（group D）for postoperative analgesia.The VAS at 6,12,24 and 48 hafter caesarean section when patients at rest,movement and uterine cramping were record.Also a questionnaire survey of analgesia satisfaction was completed at 48 hafter surgery.Dexmedetomidine concentration in the breast milk was detected by HPLC-MS/MS for the calculation of the relative infant dose（RID）.Results At 6,12 and 24 hafter operations,VAS in group D at rest,movement and uterine cramping,were significantly lower than that in group C（P〈0.05）.At 48 hafter operations,VAS in group D at movement was significantly lower than that in group C（P〈0.05）.The patients in group D showed higher degree of analgesia satisfaction than group C（P〈0.05）.Breast milk samples were collected from 15 patients.The RID of dexmedetomidine was（0.197± 0.114）%in group D.Conclusion Intravenous infusion of dexmedetomidine at0.05μg·kg^（-1）·h^（-1） is safe in healthy parturients for baby breastfeeding when combined with butorphanol in PCIA for satisfactory analgesia.

关 键 词：右美托咪定 哺乳 剖宫产术 镇痛 

分 类 号：R614[医药卫生—麻醉学]