右美托咪定用于术后硬膜外镇痛的效果及对体感诱发电位和血清髓鞘碱性蛋白的影响

Patient controlled epidural analgesia with dexmedetomidine during cesarean section did not impair somatosensory evoked potentials and serum myelin basic protein

目的观察右美托咪定（dexmedetomidine，Dex）用于剖宫产术后患者自控硬膜外镇痛（patient controlled epiduralanalgesia, PCEA）的效果及对下肢体感诱发电位（somatosensory evoked potential, SEP）和血清髓鞘碱性蛋白（myelin basic protein，MBP）的影响。方法术后行PCEA的剖宫产产妇120例，采用随机数字表法分为3组（每组40例）：0．1％罗哌卡因组（R组）、0．002％吗啡＋0．1％罗哌卡因组（RM组）、2μg／kgDex＋0．1％罗哌卡因组（RD组），观察记录产妇术后2h（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）、48h（R）的VAS评分、警觉-镇静（observer’s assessment of alertness／sedation，OAA／S）评分、HR、MAP以及手术前后下肢SEP、血清MBP、术后肛门排气时间及副作用发生情况。结果RM组在T3、T4、T5时的VAS评分为（1．8±0．8）、（1．8±0．8）分和（1．9±0．9）分，RD组为（1．7±0．6）、（1．9±0．7）分和（1．9±0．5）分，均低于R组的（2．1±0．6）、（2．3±0．6）分和（2．3±0．6）分（P〈0．05），RM和RD组间比较，差异无统计学意义（P〉0．05）；3组镇痛满意率比较，差异无统计学意义（P〉0．05）；3组产妇各时点的OAA／S评分差异无统计学意义（P〉0．05）；RM组术后恶心、头晕与皮肤瘙痒发生率（32％、15％与18％）高于R组（12％、0与0）和RD组（12％、2％与2％）（P〈0．05）；3组产妇术后下肢SEP和血清MBP与术前比较，差异无统计学意义（P〉0．05）。结论Dex2μg／kg用于剖宫产术后PCEA时对产妇下肢SEP和血清MBP无明显影响，镇痛效果满意且副作用少。

Objective To investigate whether patient controlled epidural analgesia （PCEA） with dexmedetomidine （Dex） during cesarean section has no effect on somatosensory evoked potential （SEP） upon lower limb stimulation and serum myelin basic protein （MBP）. Methods A total of one hundred and twenty puerperants receiving cesarean section were randomly divided into three groups （n=40）： group R received 0.1% ropivacaine only, group RM received 0.002%morphine＋0.1% ropivacaine, group RD received 2 μg/kg Dex＋0.1% ropivacaine. VAS score, observer＇s assessment of alertness/sedation （OAA/S） score, HR, MAP were examined 2 h（T1）, 4 h（T2） ,8 h（T3） ,12 h（T4）, 24 h（T5） and 48 h（T6） after surgery. SEPs and concentrations of serum MBP were tested before and after surgery. Adverse effects were also assessed. Results VAS scores at T3, T4, T5 of group RM （1.8±0.8, 1.8±0.8, 1.9± 0.9） and RD （1.7±0.6, 1.9±0.7, 1.9±0.5） were lower than those of group R （2.1±0.6, 2.3±0.6, 2.3±0.6）（P〈0.05）. There was no significant difference between group RM and RD （P〉0.05）. Satisfaction rates of analgesia and OAA/S scores had no significant difference among three groups （P〉0.05）. Incidence of nausea, dizziness and pruritus of group RM （32%, 15%, 18%） were higher than those of group R （12%, 0, 0） and group RD （12%, 2%, 2%）（P〈0.05）. There was no significant difference in amplitude of SEP and serum MBP in all groups between before and after operation （P〉0.05）. Conclusions Dex 2μg/kg used for PCEA after cesarean section did not affect serum MBP and SEP, therefore, is a safe analgesic with minimal adverse effect.