右美托咪定联合罗哌卡因程控硬膜外间歇脉冲注入对妊娠期糖尿病产妇血糖的影响  

Effect of dexmedetomidine combined with ropivacaine programmed intermittent epidural bolus on blood glucose in pregnant women with gestational diabetes mellitus

作　　者：黄彦逵 刘慧慧[1] 孙雪[1] 王勇[1] 马武华[1] Huang Yankui;Liu Huihui;Xue Sun;Wang Yong;Ma Wuhua(Department of Anesthesiology,The First Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510405,China)

机构地区：[1]广州中医药大学第一附属医院麻醉科,广东广州510405

出　　处：《中国妇幼健康研究》2023年第5期96-102,共7页Chinese Journal of Woman and Child Health Research

摘　　要：目的 探讨右美托咪定联合低剂量罗哌卡因程控硬膜外间歇脉冲注入(PIEB)对妊娠期糖尿病产妇围术期血糖的影响。方法 选取2020年6月至2022年2月广州中医药大学第一附属医院收治的80例妊娠期糖尿病待产产妇为研究对象,根据使用不同硬膜外镇痛方法,将其随机分为PIEB组与持续背景输注(CEI)组,两组各40例,均采用右美托咪定联合低剂量罗哌卡因进行分娩镇痛。比较两组产妇临床资料和围术期的血糖浓度、血浆皮质醇浓度、肾上腺素浓度;采用视觉模拟评分法(VAS)评估产妇不同时间的镇痛效果;比较两组产妇围术期镇痛的满意效果和不良反应的发生情况,以及两组新生儿出生时的血糖浓度和出生1min、5min时的Apgar评分。结果 PIEB组产妇的胰岛素使用量和自控镇痛按压次数均明显低于CEI组(t值分别为10.882、5.889,P<0.05)。PIEB组产妇T1、T3、T4、T5时点的血糖浓度及T1~T5时点的血浆皮质醇浓度和肾上腺素浓度均明显低于CEI组(t=2.084~21.299,P<0.05);PIEB组产妇T2时点的血糖浓度和肾上腺素浓度均明显高于T0时(t值分别为18.552、2.467,P<0.05);CEI组产妇T1~T5时点的血糖浓度(t=2.963~16.757,P<0.05)、血浆皮质醇浓度(t=2.562~4.328,P<0.05)、肾上腺素浓度(t=2.123~3.896,P<0.05)均明显高于T0时。PIEB组产妇T4、T5时点的VAS评分均明显低于CEI组(t值分别为12.764、18.692,P<0.05);两组产妇在实施镇痛后T1~T5时点的VAS评分均明显低于T0时(t=13.679~27.784,P<0.05)。PIEB组产妇围术期镇痛满意率明显高于CEI组(χ^(2)=5.000,P<0.05),PIEB组产妇不良反应总发生率明显低于CEI组(χ^(2)=4.021,P<0.05)。PIEB组新生儿出生即刻的血糖浓度明显高于CEI组(t=7.013,P<0.05),两组新生儿出生1min、5min Apgar评分比较差异均无统计学意义(P>0.05)。结论 右美托咪定联合低剂量罗哌卡因PIEB对妊娠期糖尿病产妇围术期镇痛效果明显,有利于维持其分娩过程血糖的稳定Objective To investigate the effect of dexmedetomidine combined with low dose ropivacaine programmed intermittent epidural bolus technique(PIEB) on perioperative blood glucose of pregnant women with gestational diabetes mellitus.Methods From June 2020 to February 2022,a total of 80 expectant mothers with gestational diabetes admitted to the first affiliated hospital of Guangzhou University of Chinese Medicine were selected as the research objects, they were randomly divided into PIEB group and continuous epidural infusion group(CEI) according to different epidural analgesia methods, with 40 cases in each group, both groups received dexmedetomidine combined with low dose ropivacaine for labor analgesia.The clinical data and perioperative blood glucose concentration, plasma cortisol concentration and epinephrine concentration were compared between the two groups.Visual analogue scale(VAS) was used to evaluate the analgesic effect of puerpera at different time points, the satisfactory effects of perioperative analgesia and the occurrence of adverse reactions were compared between the two groups, as well as the blood glucose concentration at birth and Apgar score at 1min and 5min after birth.Results The amount of insulin used and the number of self-controlled analgesia pressing in PIEB group were significantly lower than those in CEI group(t=10.882 and 5.889,respectively, P<0.05).The blood glucose concentrations at T1,T3,T4 and T5 and the plasma cortisol and epinephrine concentrations at T1-T5 in PIEB group were significantly lower than those in CEI group(t=2.084-21.299,P<0.05).The blood glucose concentration and epinephrine concentration in PIEB group at T2 were significantly higher than those at T0(t=18.552 and 2.467,respectively, P<0.05).The blood glucose concentration(t=2.963-16.757,P<0.05),plasma cortisol concentration(t=2.562-4.328,P<0.05) and epinephrine concentration(t=2.123-3.896,P<0.05) at T1-T5 in CEI group were significantly higher than those at T0.The VAS scores in PIEB group were significantly lower tha

关 键 词：程控硬膜外间歇脉冲注入 妊娠期糖尿病 血糖 右美托咪定 罗哌卡因 

分 类 号：R173[医药卫生—妇幼卫生保健]