不同剂量右美托咪定联合曲马多对剖宫产术后静脉镇痛效果比较

Effect of Different Doses of Dexmedetomidine Combined with Tramadol on Intravenous Analgesia After Cesarean Section

目的:探讨不同剂量右美托咪定联合曲马多对剖宫产术后静脉镇痛效果。方法:选取2018年10月-2019年10月于本院择期行剖宫产的产妇120例,采用随机数字表法将其分为A、B、C、D组,每组30例。四组均在腰硬联合麻醉(CSEA)下完成剖宫产术,术后行自控静脉镇痛(PCIA),A组给予右美托咪啶0 μg/kg,B组给予1 μg/kg,C组给予1.5 μg/kg,D组给予2 μg/kg。比较术后6、12、24、48 h各组静息状态下视觉模拟评分法(visual analogue score,VAS)和Ramsay评分,比较各组不良反应发生情况。结果:术后6、12、24、48 h,C组与D组VAS评分均低于A组与B组(P<0.05)。术后6、12、24、48 h,C组Ramsay评分均优于A组与B组(P<0.05);术后6、12、24 h,D组Ramsay评分均优于A组与B组(P<0.05);术后48 h,D组Ramsay评分优于A组(P<0.05);术后12、48 h,B组Ramsay评分均优于A组(P<0.05)。C组不良发应反生率最低,但各组不良反应发生情况比较,差异均无统计学意义(P>0.05)。结论:右美托咪定联合曲马多对剖宫产术后静脉镇痛效果确切,推荐使用右美托咪定剂量为1.5 μg/kg,镇痛效果显著且临床具有安全性。

Objective:To investigate the effect of different doses of Dexmedetomidine combined with Tramadol on intravenous analgesia after cesarean section.Method:A total of 120 parturients undergoing elective cesarean section in our hospital from October 2018 to October 2019 were selected.They were divided into groups A,B,C and D by random number table method,with 30 cases in each group.All four groups underwent cesarean section under combined lumbar epidural anesthesia (CSEA) and underwent postoperative controlled intravenous analgesia (PCIA).Group A was given Dexmedetomidine 0 μg/kg,group B was given 1 μg/kg,group C was given 1.5 μg/kg,and group D was given 2 μg/kg.Visual analogue score (VAS) and Ramsay score in each group were compared at 6,12,24 and 48 h after surgery.The occurrence of adverse reactions in each group was compared.Result:At 6,12,24 and 48 h after surgery,VAS scores of group C and group D were lower than those of group A and group B (P<0.05).At 6,12,24 and 48 h after surgery,Ramsay score of group C were better than those of group A and group B (P<0.05).At 6,12,24 h after surgery,Ramsay score of group D were better than those of group A and group B (P<0.05).At 48 h after surgery,Ramsay score of group D were better than those of group A (P<0.05).At 12 and 48 h after surgery,Ramsay scores in group B were better than those in group A (P<0.05).The incidence of adverse reactions in group C was the lowest,but there was no significant difference in occurrence of adverse reactions in each group (P>0.05).Conclusion:Dexmedetomidine combined with Tramadol is effective for intravenous analgesia after cesarean section.It is recommended to use dexmedetomidine at a dose of 1.5 μg/kg,with significant analgesic effect and safety.