不同剂量右美托咪定联合舒芬太尼和罗哌卡因对剖宫产术后自控硬膜外镇痛的效果  

Effects of different doses of dexmedetomidine combined with sufentanil and ropivacaine on patient-controlled epidural analgesia after cesarean section

作　　者：邓喆[1] 张石晶 陈维安[1] 唐平 黄伟波[1] 覃之人[1] 黎哲敏[1] 张丽珍 DENG Zhe;ZHANG Shijing;CHEN Weian;TANG Ping;HUANG Weibo;QIN Zhiren;LI Zhemin;ZHANG Lizhen(Department of Anesthesiology,Beihai People's Hospital,Beihai 536000,Guangxi,China;Department of Critical Care Medicine,Beihai People's Hospital,Beihai 536000,Guangxi,China)

机构地区：[1]广西北海市人民医院麻醉科,广西北海536000 [2]广西北海市人民医院重症医学科,广西北海536000

出　　处：《右江医学》2022年第4期269-274,共6页Chinese Youjiang Medical Journal

基　　金：广西卫生和计划生育委员会自筹经费科研课题(Z20170074)。

摘　　要：目的探讨不同剂量右美托咪定联合舒芬太尼和罗哌卡因对剖宫产术后自控硬膜外镇痛(PCEA)的效果。方法选取2017年4月至2018年12月期间在北海市人民医院拟行择期或急诊腰硬联合麻醉下剖宫产手术的150例患者作为研究对象。按随机数字表分为A、B、C三组,每组50例。三组在术后PCEA均给予舒芬太尼0.4μg/mL+0.15%盐酸罗哌卡因药物镇痛,并在此基础上增加不同浓度的右美托咪定,A组予右美托咪定0.8μg/mL,B组予右美托咪定1.2μg/mL,C组予右美托咪定1.6μg/mL。观察各组产妇术后48 h内PCEA有效按压次数、肛门排气时间以及术后6 h、12 h、24 h、48 h的视觉模拟评分(VAS)、术后48 h内并发症发生情况。结果A组术后48 h内PCEA有效按压次数高于B组和C组(P<0.05);A组、B组的肛门排气时间分别短于C组(P<0.05)。A组术后6 h、12 h、24 h、48 h的VAS评分高于B组、C组(P<0.05);B组与C组术后6 h、12 h、24 h、48 h的VAS评分比较,差异均无统计学意义(P>0.05)。C组术后48 h内并发症发生率为28.0%,明显高于A组、B组的6.0%,差异有统计学意义(χ^(2)=8.575,P=0.003),B组与A组的并发症发生率比较,差异无统计学意义(P>0.05)。结论右美托咪定浓度在1.2μg/mL配伍舒芬太尼、罗哌卡因在剖宫产术后PCEA中的镇痛效果好、安全、并发症少,优于右美托咪定浓度0.8μg/mL、1.6μg/mL的效果。Objective To explore the effect of different doses of dexmedetomidine combined with sufentanil and ropivacaine on patient-controlled epidural analgesia(PCEA)after cesarean section.Methods A total of 150 patients undergoing cesarean section under elective or emergency combined spinal-epidural anesthesia in Beihai People's Hospital from April 2017 to December 2018 were selected as research objects.According to random number table,they were divided into group A,group B,and group C,with 50 cases in each group.All groups were given sufentanil 0.4μg/mL+0.15%ropivacaine hydrochloride for analgesia after PCEA,and on this basis,different concentrations of dexmedetomidine were added.The group A were given 0.8μg/mL of dexmedetomidine,the group B were given 1.2μg/mL of dexmedetomidine,and the group C were given 1.6μg/mL of dexmedetomidine.And then,the number of effective PCEA compression,anal exhaust time,and visual analogue scale(VAS)at 6 hours,12 hours,24 hours,and 48 hours after operation as well as the occurrence of complications within 48 hours after operation were observed between groups.Results The number of effective PCEA compression in the group A was higher than that of the group B and the group C within 48 hours after surgery(P<0.05).The anal exhaust time of the group A and the group B was respectively shorter than that of the group C(P<0.05).The VAS scores of the group A at 6 hours,12 hours,24 hours,and 48 hours after surgery were higher than those of the group B and the group C(P<0.05).There was no statistically significant difference in VAS scores between the group B and the group C at 6 hours,12 hours,24 hours,and 48 hours after surgery(P>0.05).The incidence of complications in the group C was 28.0%within 48 hours after surgery,which was significantly higher than that in the group A and the group B(6.0%),and the difference was statistically significant(χ^(2)=8.575,P=0.003).There was no statistically significant difference in the incidence of complications between the group B and the group A(P>0.05).Conclu

关 键 词：右美托咪定 舒芬太尼 罗哌卡因 剖宫产 硬膜外自控镇痛 

分 类 号：R614.42[医药卫生—麻醉学]