右美托咪定用于硬膜外分娩镇痛中突破性疼痛的临床回顾分析  

Clinical Retrospective Analysis of Dexmedetomidine Used for Breakthrough Pain in Labor Analgesia

作　　者：黄惠琼 廖艺聪 贾俊香 HUANG Huiqiong;LIAO Yicong;JIA Junxiang(Department of Anesthesiology,Women and Children’s Hospital,School of Medicine,Xiamen University,Xiamen Fujian 361000,China)

机构地区：[1]厦门大学附属妇女儿童医院/厦门市妇幼保健院麻醉科,福建厦门361000

出　　处：《中国卫生标准管理》2022年第24期134-139,共6页China Health Standard Management

摘　　要：目的回顾性分析右美托咪定用于硬膜外分娩镇痛突破性疼痛的安全性和有效性。方法通过提取厦门大学附属妇女儿童医院手术麻醉电子病历系统中的分娩镇痛记录单数据。回顾性分析2019年8月—2022年7月在厦门大学附属妇女儿童医院产房行分娩镇痛后出现突破性疼痛的单胎头位初产妇284例,年龄20~40岁,美国麻醉医师协会(American society of anesthesiologists,ASA)Ⅰ或Ⅱ级,所有产妇使用相同的硬膜外镇痛方式和相同的镇痛配方。当实施完分娩镇痛的产妇出现突破性疼痛时,根据麻醉药物不同分为右美托咪定(dexmedetomidine)组(RD组,n=128)和对照组(R组,n=156)。RD组硬膜外腔推注0.08%罗哌卡因+右美托咪定0.5μg/mL,R组给予0.08%罗哌卡因。比较两组产妇疼痛视觉模拟评分(visual analog score,VAS)评分、镇静评分Ramsay评分、运动阻滞Bromage评分、给药时间间隔、给药次数、产程时间、产后出血量,记录新生儿Apgar评分和产妇不良反应。结果与给药前(T_(0))比较,T_(1)、T_(2)、T_(3)时两组产妇的VAS均明显降低(P<0.05),RD组在T_(2)时点相比R组VAS明显下降(P<0.05);Remsay评分在T_(2)时点最高,比R组显著升高(P<0.05)。RD组的VAS评分在T_(1)、T_(2)和T_(3)时明显低于R组(P<0.05);Remsay评分在T_(1)、T_(2)时明显高于R组(P<0.05)。RD组给药时间间隔长于R组,给药次数少于R组(P<0.05)。结论低浓度罗哌卡因(0.08%)复合右美托咪定(0.5µg/mL)可以显著减轻硬膜外分娩镇痛中的突破性疼痛,不良反应少,安全性高,推荐临床广泛使用。Objective To retrospectively analyze the safety and effectiveness of dexmedetomidine for breakthrough pain in labor analgesia.Methods By extracting the data of delivery analgesia record in the electronic medical record system of surgical anesthesia in Women's and Children's Hospital of Xiamen University,a total of 284 primipara with single fetal head position who had breakthrough pain after delivery analgesia in delivery room of Women and Children’s Hospital,School of Medicine,Xiamen University from August 2019 to July 2022,aged 20-40 years,American society of anesthesiologists gradeⅠorⅡ.All the primipara used the same analgesia mode and the same analgesia formula.When breakthrough pain occurs in the parturients who had finished the delivery analgesia,they were divided into dextrometomidine group(RD group,n=128)and control group(R group,n=156)according to different anesthetics.In RD group,0.08%ropivacaine+0.5μg/mL dexmedetomidine was injected into epidural space,while in R group,0.08%ropivacaine was given.The pain visual analog score(VAS),ramsay score,bromage score,administration interval,administration times,labor process time,postpartum hemorrhage volume of the two groups of parturients were compared,and the Apgar score of the newborn and adverse reactions of the parturients were recorded.Results Compared with that before administration(T_(0)),the VAS of both groups of parturients at T_(1),T_(2) and T_(3) were significantly lower(P<0.05).The VAS of RD group was significantly lower than that of R group at T_(2)(P<0.05),and Remsay was the highest at T_(2),which was significantly higher than that of R group(P<0.05).The VAS score of RD group at T_(1),T_(2) and T_(3) was significantly lower than that of R group(P<0.05);Remsay score in T_(1) and T_(2) was significantly higher than that in R group(P<0.05);The interval of administration in RD group was longer than that in R group,and the number of administration was less than that in R group(P<0.05).Conclusion Low concentration ropivacaine(0.08%)combined with de

关 键 词：右美托咪定 乳酸钠林格 0.08%罗哌卡因 分娩镇痛 突破性疼痛 不良反应 

分 类 号：G719[文化科学—职业技术教育学]