右美托咪定复合罗哌卡因用于产妇自控硬膜外分娩镇痛效果  

Effect of dexmedetomidine combined with ropivacaine for labor analgesiac by maternal self-controlled epidural given drugs

作　　者：崔恩惠[1] 孙剑[1] 晏明 曾雯琼 CUI Enhui;SUN Jian;YAN Ming;ZENG Wenqiong(Huai'an Maternity and Children Health Care Hospital, Huai'an, Jiangsu Province, 223002)

机构地区：[1]江苏省淮安市妇幼保健院,223002

出　　处：《中国计划生育学杂志》2020年第11期1816-1820,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨右美托咪定复合罗哌卡因在产妇自控硬膜外分娩镇痛中的应用效果。方法:选取本院2019年1—6月足月妊娠产妇90例,依据美国麻醉学会(SAS)评定Ⅰ~Ⅱ级,随机分为3组各30例,3组产妇在分娩过程中均给予硬膜外自控镇痛,A组给予0.12%罗哌卡因麻醉,B组给予0.12%罗哌卡因复合2μg/ml芬太尼自控镇痛,C组给予0.12%罗哌卡因复合2μg/ml右美托咪定自控镇痛。记录产妇镇痛分娩前(T0)、镇痛后10min(T1)、镇痛后30min(T2)、宫口全开时(T3)以及胎儿娩出即刻(T4)的心率(HR)、平均动脉压(MAP)和视觉模拟评分法(VAS)评分,记录产妇镇痛后30min的改良Bromage评分、Ramsay镇静评分,记录产妇镇痛泵按压次数、产程时间、产后2h出血量、新生儿Apgar评分和产妇满意度评分,监测产妇分娩镇痛前、胎儿娩出即刻及产后2h的血清催乳素(PRL)水平和泌乳始动时间,并记录产妇不良反应发生情况。结果:3组T1~T3时的HR和MAP均较T0时下降(P<0.05),但组间比较无差异(P>0.05);3组T1~T4时的VAS评分均较T0时降低(P<0.05),且B组和C组低于A组(P<0.05);3组产妇镇痛后30min的改良Bromage评分均为0级,C组镇痛后30min的Ramsay评分高于A组和B组,镇痛泵按压次数少于A组和B组(均P<0.05);3组第一产程时间、第二产程时间、产后2h出血量和新生儿Apgar评分无差异(P>0.05),B组和C组的产妇满意度评分均高于A组(P<0.05);C组胎儿娩出即刻和产后2h的血清PRL水平均高于A组和B组,泌乳始动时间早于A组和B组(均P<0.05);不良反应发生率A组和C组低于B组(P<0.05)。结论:对行硬膜外自控镇痛分娩产妇,给予0.12%罗哌卡因复合2μg/ml右美托咪定自控镇痛效果好,对自身血压和心率影响小,对新生儿无明显不良影响,且可促进泌乳素分泌,用药安全。Objective:To explore the effect of dexmedetomidine combined with ropivacaine for labor analgesia by maternal self-controlled epidural given drugs.Methods:90 pregnant women with full-term pregnancy were selected and were randomly divided into 3 groups(30 cases in each group)according to the gradedⅠtoⅡby the American Society of Anesthesia(SAS)from January 2019 to June 2019.All women were given epidural self-controlled analgesia during delivery,and the women in group A were given anesthesia with 0.12%ropivacaine,the women in group B were given 0.12%ropivacaine combined with 2μg/ml fentanyl,and the women in group C were given 0.12%ropivacaine combined with 2μg/ml dexmedetomidine.The heart rate(HR),mean arterial pressure of the fetus(MAP),and visual analogue scale(VAS)scores of the women in the three groups before maternal analgesia delivery(T0),10min after analgesia(T1),30min after analgesia(T2),at the full opening of the uterine cavity(T3),and immediately after delivery(T4)were recorded.The modified Bromage score and Ramsay sedation score of the women in the three groups at 30 minutes after maternal analgesia were recorded.The number of maternal analgesia pump compressions,duration of labor,2h postpartum hemorrhage amount,newborn Apgar score,and maternal satisfaction score of the women in the three groups were recorded.The onset of lactation,and the serum prolactin(PRL)level before analgesia delivery analgesia,immediately after delivery,and 2h after delivery of women in the three groups were monitored.The rate of adverse reactions of the women in the three groups was also recorded.Results:The values of HR and MAP of women in the three groups at T1-T3 were significant lower than those of women at T0(P<0.05),but there were no significant difference in the values of HR and MAP among the three groups(P>0.05).VAS score of women in the three groups at T1-T4 was significant lower than that of women at T0(P<0.05),and that of women in group A was the highest(P<0.05).The modified Bromage scores of women in the three gro

关 键 词：自控硬膜外分娩镇痛 右美托咪定 罗哌卡因 镇痛效果 

分 类 号：R47[医药卫生—护理学]