右美托咪定复合罗哌卡因用于硬膜外分娩镇痛的效果

Effect of Dexmedetomidine Combined with Ropivacaine on Epidural Labor Analgesia

目的本研究拟探讨右美托咪定作为罗哌卡因佐剂硬膜外注射用于分娩镇痛的效果,并与临床上常用的舒芬太尼复合罗哌卡因配方做比较。方法选择2018年8月-2021年8月我院阴道分娩产妇60例,美国麻醉医生协会ASA分级为Ⅰ或Ⅱ级,年龄24~35岁,BMI20~25kg/m^(2),随机分为右美组(D组,n=30)和舒芬组(S组,n=30)。两组产妇选择L1-2间隙正中入路法穿刺进行连续硬膜外分娩镇痛,两组使用药物如下:D组使用含右美托咪定(0.5μg/mL)的0.1%罗哌卡因,S组为含舒芬太尼(0.5μg/mL)的0.1%罗哌卡因。记录两组产妇入室、阻滞后10min、阻滞后30min、胎儿娩出、胎儿娩出30min后HR、MAP;记录两组产妇入室、阻滞后10min、阻滞后30min、胎儿娩出、胎儿娩出30min后疼痛VAS评分(0分为无痛,10分为无法忍受的剧痛)、Ramsay评分、运动神经阻滞Bromage评分、胎心率;记录两组胎儿娩出后1minApgar评分及5minApgar评分;记录两组产妇镇痛期间不良反应发生情况。结果与入室时比较,D组阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时MAP、HR明显降低(P<0.05);与S组比较,D组阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时MAP、HR明显降低(P<0.05)。与入室时比较,D组和S组阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时疼痛VAS评分明显降低(P<0.05),D组阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时Ramsay评分明显增加(P<0.05);与S组比较,D组入室时、阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时疼痛VAS评分差异无统计学意义(P>0.05),D组阻滞后10min、阻滞后30min、胎儿娩出和胎儿娩出后30min时Ramsay评分明显增加(P<0.05);两组产妇各时间点运动神经阻滞评分、胎心率比较差异无统计学意义(P>0.05)。D组与S组胎儿娩出后1minApgar评分及5minApgar评分均为10分,两组比较差异无统计学意义(P>0.05)。结论右美托咪定作为罗哌卡因佐剂应用于硬膜外分娩镇痛,与等剂量舒芬太尼效果相当,且能为产妇提供一定程度镇静。

The purpose of this study was to investigate the effect of epidural injection of dexmedetomidine as ropivacaine adjuvant on labor analgesia,and to compare it with sufentanil combined with ropivacaine.Methods From August 2018 to August 2021,60 pregnant women with vaginal delivery in our hospital were randomly divided into Youmei group(Group D,n=30)and Shufen group(Group S,n=30).The parturients in the two groups chose L1-2 gap median approach for continuous epidural labor analgesia.The drugs used in the two groups were as follows,0.1%ropivacaine containing dexmedetomidine(0.5μg/mL)in group D and 0.1%ropivacaine containing sufentanil(0.5μg/mL)in group S.HR and MAP were recorded at 10 min,30 min after block,30 min after fetal delivery and 30 min after fetal delivery in the two groups;VAS scores(for painless and 10 for unbearable severe pain),Ramsay score,Bromage score of motor nerve block and fetal heart rate were recorded;Apgar score at 1 min and Apgar score at 5 min after delivery were recorded;The adverse reactions of the two groups during analgesia were recorded.Results In group D,MAP and HR decreased significantly at 10 min after block,30 min after block,30 min after fetal delivery and 30 min after fetal delivery(P<0.05);Compared with group S,map and HR in group D decreased significantly at 10 min after block,30 min after block,fetal delivery and 30 min after fetal delivery(P<0.05).Compared with the time of entry,the pain VAS score decreased significantly at 10 min,30 min,delivery and 30 min after delivery in group D and S(P<0.05),and the Ramsay score increased significantly at 10 min,30 min,delivery and 30 min after delivery in group D(P<0.05);Compared with group S,there was no significant difference in pain VAS scores in group D at the time of entry,10 min after block,30 min after block,fetal delivery and 30 min after fetal delivery(P>0.05).Ramsay scores in group D increased significantly at 10 min,30 min after block,fetal delivery and 30 min after fetal delivery(P<0.05);There was no significant difference in motor nerve block score and fetal heart rate between the two groups(P>0.05).The Apgar scores at 1 min and 5 min after delivery in group D and group S were 10 points.There was no significant difference between the two groups(P>0.05).Conclusion Dexmedetomidine as ropivacaine adjuvant has the same effect as equal dose sufentanil in epidural labor analgesia,and can provide a certain degree of sedation for pregnant women.