不同剂量右美托咪定联合布托啡诺在剖宫产术后镇痛镇静中的应用  

Application of Different Doses of Dexmedetomidine Combined with Butorphanol in Analgesia and Sedation after Cesarean Section

作　　者：刘辉[1] 王雅琳 李福龙[1] 任伟 袁莉 高艳[1] LIU Hui;WANG Yalin;LI Fulong;REN Wei;YUAN Li;GAO Yan(Department of Anesthesiology,the First Affiliated Hospital of Hebei North University,Zhangjiakou 075000,China)

机构地区：[1]河北北方学院附属第一医院麻醉科,河北张家口075000

出　　处：《医学综述》2023年第1期187-192,共6页Medical Recapitulate

基　　金：张家口市重点研发计划项目(1921060D)。

摘　　要：目的分析不同剂量右美托咪定联合布托啡诺在剖宫产术后镇痛镇静中的应用效果。方法采用便利抽样法选取2020年1月至2021年12月在河北北方学院附属第一医院择期行剖宫产术的180例产妇为研究对象,根据剖宫产术后镇痛泵镇痛的不同药物组成将其分为对照组、复合A组、复合B组,每组60例,对照组采用芬太尼15μg/kg+帕洛诺司琼0.25 mg,复合A组采用右美托咪定2.0μg/kg+布托啡诺4 mg+芬太尼10μg/kg+帕洛诺司琼0.25 mg,复合B组采用右美托咪定1.0μg/kg+布托啡诺4 mg+芬太尼10μg/kg+帕洛诺司琼0.25 mg,给药速度设置为2 ml/h,持续镇痛48 h,比较三组术后视觉模拟评分法(VAS)评分、镇静评分(SS)评分、催乳素水平以及不良反应发生情况。结果术后4、8、12、24、36、48 h的VAS评分、SS评分、催乳素水平的主效应差异有统计学意义(P<0.01),且随术后时间的延长,三组VAS评分、SS评分逐渐降低,而催乳素水平逐渐升高(P<0.05);不考虑测量时间,三组间术后VAS评分、SS评分、催乳素水平的主效应差异有统计学意义(P<0.01);VAS评分、SS评分的时点间与组间不存在交互作用(P>0.05),催乳素水平的时点间与组间存在交互作用,且复合A组变化最明显(P<0.01)。复合A组和复合B组低血压及总不良反应发生率均低于对照组[0、0比6.67%(4/60),10.00%(10/60)、8.33%(5/60)比34.67%(19/60)](P<0.05或P<0.01)。结论2.0μg/kg的右美托咪定联合布托啡诺用于剖宫产术后镇痛镇静的效果最佳,更有助于降低不良反应发生率,且对剖宫产术后产妇泌乳的影响较小。Objective To analyze the effect of different doses of dexmedetomidine combined with butorphanol in analgesia and sedation after cesarean section.Methods A total of 180 women who underwent elective cesarean section in the First Affiliated Hospital of Hebei North University from Jan.2020 to Dec.2021 were selected by convenient sampling method.According to the different drug compositions of analgesia pump after cesarean section,they were divided into a control group,a compound A group and a compound B group,with 60 cases in each group.The control group received fentanyl 15μg/kg+palonosetron 0.25 mg;the compound A group received dexmedetomidine 2.0μg/kg+butorphanol 4 mg+fentanyl 10μg/kg+palonosetron 0.25 mg;the compound B group received dexmedetomidine 1.0μg/kg+butorphanol 4 mg+fentanyl 10μg/kg+palonosetron 0.25 mg,and the rate of administration was set to 2 ml/h,for continuous analgesia for 48 h.Postoperative visual analogue scale(VAS)score,sedation scale(SS)score,prolactin level and adverse reactions were compared among the three groups.Results There were significant differences in the main effects of VAS score,SS score and prolactin level at 4,8,12,24,36 and 48 h after operation(P<0.01).With the extension of postoperative time,the VAS score and SS score of the three groups gradually decreased,while the prolactin level gradually increased(P<0.05).Regardless of measurement time,the main effects of VAS score,SS score and prolactin level were significantly different among the three groups(P<0.01).There was no interaction in VAS score and SS score between the time points and the groups(P>0.05),but there was interaction in prolactin level between the time points and the groups,and the change of the compound A group was the most significant(P<0.01).The incidence of hypotension and total adverse reactions in compound A group and compound B group were lower than those in the control group[0,0 vs 6.67%(4/60),10.00%(10/60),8.33%(5/60)vs 34.67%(19/60)](P<0.05 or P<0.01).Conclusion Dexmedetomidine(2.0μg/kg)combined with

关 键 词：剖宫产 宫缩痛 右美托咪定 布托啡诺 呼吸抑制 产妇泌乳 

分 类 号：R719.8[医药卫生—妇产科学] R614[医药卫生—临床医学]