右美托咪定静脉输注联合程序化间断硬膜外给药用于分娩镇痛的临床观察

Clinical Observation of Intravenous Dexmedetomidine Combined with Programmed Intermittent Epidural Bolus on Labor Analgesia

目的:探讨右美托咪定静脉输注联合程序化间断硬膜外给药(PIEB)用于分娩镇痛的临床效果及安全性。方法:接受硬膜外分娩镇痛的初产妇160例,随机分为C组(PIEB分娩镇痛)和D组(右美托咪定静脉输注联合PIEB分娩镇痛),每组80例。观察两组患者镇痛前,镇痛后30 min、1 h、2 h及停止镇痛时平均动脉压(MBP)和心率(HR),比较两组镇痛后5 min、10 min、1 h,宫口开全时数字疼痛强度量表(NRS)评分及镇痛起效时间、显效时间、维持时间。记录两组第二产程时间、硬膜外药物用量、产钳助产率、剖宫产率、出血量、镇痛期间胎心率。测定两组产妇分娩后1 h肾上腺素(AD)与去甲肾上腺素(NA)血浆浓度及凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)及血浆纤维蛋白原(FIB)含量。记录两组产妇药品不良反应和新生儿Apgar评分及D组脐带血右美托咪定浓度。结果:D组镇痛后1 h、停止镇痛时HR低于C组(P <0. 05),但在正常范围内。D组不同时点NRS评分均低于C组(P <0. 05);镇痛起效时间、显效时间短于C组、维持时间多于C组(P <0. 05)。D组第二产程时间和硬膜外药物用量少于C组(P <0. 05)。分娩后1 h,两组产妇的AD、NA、PT、APTT、FIB等指标比较,差异有统计学意义(P <0. 05)。两组产妇药品不良反应和新生儿Apgar评分比较,差异无统计学意义(P> 0. 05)。D组脐带血右美托咪定浓度为(97. 8±26. 4) pg·ml^(-1),新生儿未发生呼吸抑制。结论:与PIEB单用相比,右美托咪定静脉输注联合PIEB用于分娩镇痛的效果较好,不仅可缩短第二产程、减少硬膜外药物用量,还能减轻产妇的应激反应和产后高凝状态。

Objective：To investigate the effects of intravenous dexmedetomidine combined with programmed intermittent epidural bolus（ PIEB） on labor analgesia. Methods：160 cases of primiparas requesting epidural labor analgesia were divided randomly into group C（ with PIEB,n = 80） and group D（ with intravenous dexmedetomidine combined with PIEB,n = 80）. MBP,HR at before analgesia,30 min after analgesia,1 h after analgesia,2 h after analgesia,stopping analgesia were observed in two groups. NRS scores at 5 min after analgesia,10 min after analgesia,1 h after analgesia,uterine mouth opening and the analgesic onset time,the effective time,the sustained time were compared between two groups. The second stage of labor,the consumption of epidural drugs,the forceps production rate,the cesarean section rate,amount of bleeding,fetal heart rate during analgesia were recorded in two groups. AD,NA and PT,APTT,Fib at 1 h after labor were determined in two groups. The maternal adverse reaction,Apgar scores of neonates in two groups,dexmetomidine concentration of umbilical cord blood in group D were recorded. Results：①HR at 1 h after analgesia,stopping analgesia in group D were lower than those in group C（ P 〈 0. 05）,but within normal range.②NRS scores at different time points in group D were lower than those in group C（ P 〈 0. 05）,the analgesic onset time,the effective time in group D were less than those in group C（ P 〈 0. 05）,the sustained time were more than those in group C（ P 〈 0. 05）.③The second stage of labor,the consumption of epidural drugs in group D were less than those in group C（P 〈 0. 05）.④AD,NA,PT,APTT,Fib at before analgesia were not statistically different（P 〉 0. 05） and at 1 h after analgesia had statistical difference in two groups（ P 〈 0. 05）.⑤The maternal adverse reaction rates,Apgar scores of neonates had no statistical difference in two groups（ P 〉 0. 05）. Dexmetomidine concentration of umbilical cord blood in group D was（97. 8± 26. 4） pg · ml-1,no respiratory depression occurred in the newborn. Conclusion：Compared with PIEB,intravenous dexmedetomidine combined with PIEB have better effects on labor analgesia,and can shorten the second stage of labor,lessen the consumption of epidural drugs,reduce maternal stress response and postpartum hypercoagulability.