右美托咪定联合低浓度罗哌卡因在产程早期分娩镇痛的临床应用

Clinical application of dexmedetomidine combined with low concentration ropivacaine for early labor analgesia

目的 探讨产程早期硬膜外阻滞麻醉中右美托咪定联合不同剂量罗哌卡因的效果及安全性.方法 前瞻性选取2019年1~6月我院收治的120例临产产妇为研究对象,根据罗哌卡因剂量不同分为四组,每组30例,A组:0.075% 盐酸罗哌卡因+右美托咪定0.75μg/mL;B:0.1% 盐酸罗哌卡因+右美托咪定0.75μg/mL;C组:0.125%盐酸罗哌卡因+右美托咪定0.75μg/mL;D组:0.15%盐酸罗哌卡因+右美托咪定0.75μg/mL,比较四组产妇镇痛前(T0)、镇痛后10min(T1)、镇痛后2h(T2)、镇痛后4h(T3)、镇痛后6h(T4)、宫口全开时(T5)、产后(T6)VAS评分,T2、T3、T4、T6时四组产妇Bromage、Piper评分,比较四组患者第一产程、第二产程、第三产程时间和四组新生出生后1、5min Apgar评分和脐血血气分析指标(pH值、PaO2、PaCO2、乳酸值)水平以及不良反应发生情况.结果 A、B、C、D组T0时VAS评分最高,随着镇痛药物的应用,VAS评分逐渐降低,至T5时降至最低(P<0.05);A、B、C、D组不同时间点VAS评分差异无统计学意义(P>0.05);A、B、C、D组各时间点Bromage评分差异均无统计学意义(P>0.05);T3、T4、T6时A、C、D组Piper评分明显高于B组(P<0.05),A、C、D三组组间差异无统计学意义(P>0.05);A、B组第一产程时间明显短于C、D组(P<0.05),A、B、C、D组第二、三产程时间差异均无统计学意义(P>0.05);A、B、C、D新生儿出生后1、5min Apgar评分和脐血pH值、PaO2、PaCO2、乳酸值差异无统计学意义(P>0.05);A、B、C、D组应用右美托咪定联合罗哌卡因麻醉镇静后发生产妇心率异常、产妇血压异常、胎儿心率异常、尿潴留、恶心呕吐、皮肤瘙痒、寒战等不良发生率分别为A、B、C组不良反应发生率分别为8.33%、10.00%、15.83%均明显低于D组31.67%(P<0.05),且A、B、C三组差异无统计学意义(P>0.05).结论 产程早期予以0.075%罗哌卡因联合0.75μg/mL右美托咪定硬膜外阻滞麻醉镇痛效果确切,可加快产程进展,减轻产妇疲乏感,此外不会明显增加麻醉药品不良反应发生率,可在临床广泛应用.

Objective To investigate and analyze the efficacy and safety of dexmedetomidine combined with different doses of ropivacaine in epidural block anesthesia during early labor.Methods 120 maternal women admitted to our hospital from January to June 2019 were prospectively selected.According to the dose of ropivacaine,the patients were divided into the following four groups with 30 patients in each group:group A(0.075%ropivacaine hydrochloride and dexmedetomidine 0.75μg/mL),B(0.1%ropivacaine hydrochloride and dexmedetomidine 0.75μg/mL),group C(0.125%ropivacaine hydrochloride and dexmedetomidine 0.75μg/mL)and group D(0.15%ropivacaine hydrochloride and dexmedetomidine 0.75μg/mL).The VAS scores before analgesia(T0),at 10 min(T1),2h(T2),4h(T3),6h(T4)after analgesia,when the cervix was fully dilated(T5)and postpartum(T6),as well as Bromage and Piper scores at T2,T3,T4 and T6 of maternal women in four groups were compared and analyzed.The first,second and third stage of labor of maternal women in the four groups,as well as the Apgar scores at 1 and 5min after birth,the umbilical cord blood gas analysis indicators(pH,PaO2,PaCO2 and lactate value)and the occurrence of adverse reactions of the neonates in the four groups were also compared and analyzed.Results The VAS scores at T0 in group A,B,C and D were the highest.With the application of analgesic drugs,the VAS scores gradually decreased to the lowest at T5(P<0.05).There were no significant differences in the VAS scores between group A,B,C and D(P>0.05).There were no significant differences in the Bromage scores between group A,B,C and D(P>0.05).The Piper scores at A3,T4 and T6 in group A,C and D were significantly higher than those in group B(P<0.05),and there were no significant differences between group A,C and D(P>0.05).The first stage of labor in group A and group B was significantly shorter than that in group C and D(P<0.05),and there were no significant differences in the second and third stage of labor in group A,B,C and D(P>0.05).There were no significant differences in Apgar scores,umbilical cord blood pH values,PaO2,PaCO2 and lactate values at 1 and 5 min after birth in group A,B,C and D(P>0.05).After anesthesia with dexmedetomidine combined with ropivacaine,the incidences of adverse reactions,such as abnormal maternal heart rate and blood pressure,abnormal fetal heart rate,urinary retention,nausea and vomiting,skin itching,chills,in group A,B and C were 8.33%,10.00%,and 15.83%,respectively,which were significantly lower than that in group D(31.67%,P<0.05),and there were no significant differences between group A,B and C(P>0.05).Conclusion Epidural block anesthesia with 0.075%ropivacaine combined with 0.75μg/mL dexmedetomidine during early labor shows exact analgesic effects,which accelerate the progress of labor,reduce maternal fatigue,and will not significantly increase the incidence of adverse reactions to anesthetics.Therefore,it can be widely applied in clinical practice.