硬膜外腔应用右美托咪定辅助分娩镇痛的临床效果分析

Injection of dexmedetomidine into epidural space in assistance of labor analgesia

目的评价硬膜外腔应用罗哌卡因复合右美托咪定（Dexmedetomidine：DEX）混合液于分娩镇痛的效果、临产妇的血流动力学情况及其对新生儿的影响。方法将150例临产妇随机分为罗哌卡因复合右美托咪定组（RD）和罗哌卡因复合曲马多组（RT），均行硬膜外分娩镇痛，观察（1）各临产妇感觉神经阻滞情况；（2）宫口开至3、5、7cm及开全时的产妇平均动脉压（MAP）、心率（HR）及视觉模拟评分法的疼痛评分（VAS）；（3）各产程的时间及产后出血量；（4）镇痛过程中的不良反应情况；（5l新生儿出生即时脐静脉血气分析及出生后1min、5min时的Apgar评分。结果RD组在阻滞起效时间和达最高阻滞平面时间均短于RT组[（6．380±1．008）min比（7．880±1．409）min和（11．540±1．439）min比（13．040±1．748）min]，最高阻滞平面亦高于RT组（均P〈0．05）；RD组在宫口扩张至3、5、7cm时临产妇的MAP明显低于RT组（均P〈0．01）；RD组临产妇的HR、VSA在各记录点均明显低于RT组（均P〈0．01）；RD组的恶心、呕吐、寒战发生率明显低于RT组（2．6％比9．3％、0．0％比4．O％、2．6％比8．0％）（均P〈0．01），虽然RD组心动过缓发生率高于RT组（5．3％比2．6％）（P〈0．05），但其心率均大于50次／win。结论罗哌卡因复合右美托咪定用于硬膜外腔分娩镇痛，有着良好的镇痛作用，其效果优于罗哌卡因复合曲马多，更适合分娩镇痛。

Objective To analyze the clinical effect of the injection of dexmedetomidine into epidural space in the assistance of labor analgesia and the parturients＇ hemodynamic status and its influence on the neonates. Methods A total of 150 parturients having delivery from January to June, 2017 were randomly divided into an RD group （ropivacaine combined with dexmedetomidine ） and an RT group （ropivacalne combined with tramadol）. The status of sensory nerve block, the time of labor process, the bleeding volume after delivery, and the untoward responses during labor analgesia were recorded. The mean arterial pressure（MAP） and heat rate（HR） and the score of visual analogue scale （VAS） were recorded when the dilation of cervix got to 3（T1）, 5（T2）, 7（T3）, and 10 cm （T4）. The blood samples were drawn from umbilical vein for gas analysis and the newborn Apgar scores at 1 and 5 minutes were also recorded after delivery. Results The onset time of nerve block and the time to maximum sensory nerve analgesic level [（6.380±1.008） min vs.（7.880±1.409） min and （11.540±1.439）min vs. （13.040±1.748） min, both P 〈 0.05] were shorter and the maximum sensory nerve analgesic level （P 〈 0.05） was higher in the RD group than in the RT group. The MAP at T1, T2, and T3 were significantly lower in the RD group than in the RT group, with statistical differences （all P 〈 0.01）. The HR and VAS at T1, T2, T3, and T4 were lower in the RD group than in the RT group, with statistical differences （all P 〈 0.05）. The incidences of nausea, vomiting, and shiver were significantly lower in the RD group than in the RT group （2.6% vs. 9.3%, 0.0% vs. 4.0%, and 2.6% vs. 8.0%, all P 〈 0.01）, but the incidence of sinus bradycardia was higher in the RD group than in the RT group （5.3% vs. 2.6%, P 〈 0.05）. The heart rates ofaU the parturient＇ during delivery were more than 50 beats per minute. Conclusions Ropivacaine combined with dexmedetomidine injected into the epidural space for labor analgesia can provide better abirritation and is superior to ropivacaine combined with tramadol, so it is more suitable for labor analgesia.