硬膜外注射右美托咪定复合氢吗啡酮用于剖宫产术后镇痛的效果  

Efficacy of epidural dexmedetomidine combined with hydromorphone for analgesia after cesarean section

作　　者：何晓昕 李华[1] 王琛[1] 查俊 He Xiaoxin;Li Hua;Wang Chen;Zha Jun(Department of Anesthesiology,Suzhou Science and Technology City Hospital Affiliated to Nanjing Medical University,Suzhou 215153,China)

机构地区：[1]南京医科大学附属苏州科技城医院麻醉科,215153

出　　处：《中华麻醉学杂志》2019年第12期1461-1463,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价硬膜外注射右美托咪定复合氢吗啡酮用于剖宫产术后镇痛的效果。方法择期椎管内麻醉下行剖宫产术患者40例,年龄25~35岁,体重65~85 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为2组(n=20):右美托咪定复合氢吗啡酮组(DH组)和氢吗啡酮组(H组)。胎儿取出后,DH组依次硬膜外注射右美托咪定1μg/kg、氢吗啡酮0.4 mg,H组依次硬膜外注射生理盐水0.1 ml/kg、氢吗啡酮0.4 mg。2组术后采用舒芬太尼PCIA进行镇痛补救,维持VAS评分≤3分。于术后2、4、6、12、24和48 h(T1-6)时记录Ramsay镇静评分;记录首次使用PCIA时间、舒芬太尼消耗量、肛门排气时间和皮肤瘙痒发生情况。结果与H组比较,DH组T2时Ramsay镇静评分升高,术后首次使用PCIA时间延长,舒芬太尼消耗量减少,皮肤瘙痒发生率降低(P<0.05),肛门排气时间差异无统计学意义(P>0.05)。结论硬膜外注射右美托咪定可优化氢吗啡酮用于剖宫产术后镇痛的效果。Objective To evaluate the efficacy of epidural dexmedetomidine combined with hydromorphone for analgesia after cesarean section.Methods Forty American Society of Anesthesiologists physical statusⅠorⅡpatients,aged 25-35 yr,weighing 65-85 kg,scheduled for elective cesarean section under neuraxial anesthesia,were divided into 2 groups(n=20 each)by a random number table method:dexmedetomidine combined with hydromorphone group(group DH)and hydromorphone group(group H).After the fetuses were removed,dexmedetomidine 1μg/kg and hydromorphone 0.4 mg were epidurally injected in sequence in group DH,and normal saline 0.1 ml/kg and hydromorphone 0.4 mg were epidurally injected in sequence in group H.Patient-controlled intravenous analgesia(PCIA)with sufentanil was used for rescue analgesia after operation,and Visual analogue scale score was maintained≤3 points in two groups.Ramsay sedation scores were recorded at 2,4,6,12,24 and 48 h postoperatively(T1-6).The time of first use of PCIA,sufentanil consumption,time to first flatus and occurrence of pruritus were recorded.Results Compared with group H,Ramsay sedation score were significantly increased at T2,the time of first use of PCIA after surgery was prolonged,sufentanil consumption was decreased,the incidence of pruritus was decreased(P<0.05),and no significant change was found in the time to first flatus in group DH(P>0.05).Conclusion Epidural dexmedetomidine can optimize the efficacy of hydromorphone when used for analgesia after cesarean section.

关 键 词：右美托咪啶 氢吗啡酮 镇痛 硬膜外 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]