分娩镇痛应用罗哌卡因联合右美托咪定效果研究  

Effect of ropivacaine combined with dexmedetomidine in labor analgesia

作　　者：杨万福 李洁[2] YANG Wan-fu;LI Jie(Department of Anesthesiology,Maternal and Child Health Hospital of Qinghai Province,Xining 810007,China)

机构地区：[1]青海省妇幼保健院麻醉科,青海西宁810007 [2]青海红十字医院妇产科,青海西宁810000

出　　处：《创伤与急危重病医学》2022年第6期438-441,共4页Trauma and Critical Care Medicine

基　　金：青海省卫生计生系统重点课题(2020-wjzdx-60)。

摘　　要：目的探讨在分娩镇痛中应用罗哌卡因复合右美托咪定后的效果。方法选取自2020年8月至2021年6月入院的单胎足月妊娠产妇82例为研究对象,按随机数字表法分为常规组(n=40)与观察组(n=42)。常规组采用0.068%罗哌卡因复合舒芬太尼镇痛,观察组采用0.068%罗哌卡因复合右美托咪定镇痛,观察两组分娩前(T0)、镇痛后10 min(T1)、30 min(T2)、宫口全开(T3)及胎儿娩出即刻(T4)各时间点产妇的视觉模拟评分(VAS)及心率(HR)、平均动脉压(MAP)变化;记录两组分娩后2 h出血量、第一和第二产程时间、娩出后1 min、5 min新生儿Apgar评分及分娩时不良反应(低血压、呼吸抑制、过度镇静、反流误吸)、产后第一天不良反应(头晕头痛、恶心呕吐、皮肤瘙痒、尿潴留、嗜睡)。结果两组产妇T1至T4时VAS评分均低于T0时,且观察组T1至T4时VAS评分低于常规组,差异均有统计学意义(P<0.05)。两组各时刻HR、MAP比较,差异无统计学意义(P>0.05)。在T2、T3时,两组HR、MAP均低于同组T0,差异均有统计学意义(P<0.05)。两组第一、第二产程时间及新生儿Apgar评分、产后2 h出血量、不良反应发生率比较,差异无统计学意义(P>0.05)。结论罗哌卡因复合右美托咪定镇痛效果更好,对自身血压及心率影响较小,对新生儿无明显影响,不良反应少,安全性高。Objective To investigate the effect of ropivacaine combined with dexmedetomidine in labor analgesia.Methods A total of 82 women with singleton full-term pregnancy in the hospital from August 2020 to June 2021 were selected as the research objects and divided into the observation group(n=42)and the control group(n=40)according to the random number table method.0.068%ropivacaine combined with sufentanil,and 0.068%ropivacaine combined with dexmedetomidine in the observation group.The maternal analgesia effect visual analogue scale(VAS)score,heart rate(HR)and mean arterial pressure(MAP)were observed before delivery(T0),10 min(T1)after analgesia,30 min(T2)after analgesia,uterine opening(T3)and immediately after delivery(T4).The amount of blood loss at 2 h after birth,the time of the first and second stages of labor,Apgar score of the newborn at 1 min and 5 min after birth,and adverse reactions at delivery(hypotension,respiratory depression,excessive sedation,reflux and aspiration),and adverse reactions on the first day after delivery(dizziness,headache,nausea and vomiting,skin itching,urinary retention and lethargy)were recorded.Results The VAS scores at T1 to T4 of the two groups were lower than those at T0,and the VAS scores at T1 to T4 of the observation group were lower than those of the conventional group,with statistical significance(P<0.05).There was no significant difference in HR and MAP between the two groups at each time(P>0.05).At T2 and T3,HR and MAP of the two groups were lower than T0 of the same group,the differences were statistically significant(P<0.05).There were no significant differences in the first and second stages of labor,Apgar score,postpartum blood loss 2 h after birth and incidence of adverse reactions between the two groups(P>0.05).Conclusion Ropivacaine combined with dexmedetomidine has better analgesic effect,no obvious effect on neonates,less adverse reactions,and high safety.

关 键 词：分娩镇痛 罗哌卡因 右美托咪定 

分 类 号：R714.3[医药卫生—妇产科学]