右美托咪啶复合地佐辛对剖宫产高危产妇术后疼痛及泌乳功能的影响

Effect of dexmedetomidine combined with dezocine on postoperative pain and lactation function in high-risk parturient women after cesarean section

目的 探讨右美托咪定(Dex)复合地佐辛对剖宫产高危产妇术后疼痛及泌乳功能的影响。方法 90例剖宫产高危产妇分为硬膜外腔组(E组)、静脉组(I组)和对照组(C组),各30例。E组硬膜外腔注射Dex 0.5μg/kg+地佐辛5mg;I组于15min静脉泵注Dex 0.5μg/kg+地佐辛5mg;C组注射等量生理盐水。比较术后6、12、24、48h静息、运动和宫缩疼痛视觉模拟评分法(VAS)评分及Ramsay评分,记录术前、术后第1、2天泌乳素(PRL)水平,比较不良反应及新生儿哺乳12h神经行为评分。结果 E组、I组术后12、24h静息、运动和宫缩VAS评分均低于C组(P<0.05),E组术后12、24h运动和宫缩VAS评分均低于I组(P<0.05)。E组、I组术后6、12、24hRamsay评分均低于C组(P<0.05)。术后第1、2天PRL水平比较,E组、I组均高于C组(P<0.05),E组高于I组(P<0.05)。E组、I组恶心、呕吐发生率低于C组(P<0.05),3组哺乳12h神经行为评分无明显差异(P>0.05)。结论 Dex复合地佐辛可减轻剖宫产高危产妇术后疼痛,提高镇静水平,促进泌乳功能,减少恶心、呕吐,且效果以硬膜外腔途径为佳。

Objective To investigate the effect of dexmedetomidine(Dex)combined with dezocine on postoperative pain and lactation function in high-risk parturient women after cesarean section.Methods A total of 90 high-risk parturient women who underwent cesarean section were divided into the epidural space group(group E),the intravenous group(group I)and the control group(group C),30 cases in each group.After delivery,group E received epidural injection of Dex 0.5μg/kg+dezocine 5 mg for 5 mL and intravenous injection of saline for 15 min,group I received intravenous injection of Dex 0.5μg/kg+dezocine 5 mg for 15 min and epidural injection of saline 5 mL,and group C received epidural injection of saline 5 mL and intravenous injection of saline for 15 min.The VAS scores of rest,motor,uterine contraction and Ramsay sedation scores at 6,12,24 and 48 h after operation were compared among the three groups.The prolactin(PRL)levels were recorded before operation,on the 1st and 2nd day after operation,and the adverse reactions and neonatal neurobehavioral scores at 12 h after lactation were compared among the three groups.Results The VAS scores of rest,motor and uterine contraction in group E and group I were lower than those in group C(P<0.05),and VAS scores of motor and uterine contraction in group E were lower than those in group I(P<0.05).Ramsay scores in group E and group I at 6,12 and 24 h after operation were lower than those in group C(P<0.05).At the 1st and 2nd day after operation,PRL levels in group E and group I were higher than those in group C(P<0.05),and PRL level in group E was higher than that in group I(P<0.05).The incidence of nausea and vomiting in group E and group I were lower than that in group C(P<0.05).There was no significant difference in neurobehavioral score of newborns after 12 h of lactation in the three groups(P>0.05).Conclusion Dex combined with dezocine can alleviate pain,improve sedation,promote lactation function,reduce the incidence of nausea and vomiting in high-risk parturient women with cesarean section.The epidural approach might be the best way to achieve the above effects.