右美托咪定联合氢吗啡酮对妊高征患者剖宫产术后硬膜外镇痛效果和循环的影响

The effects of dexmedetomidine combined with hydromorphine on epidural analgesia and circulation after cesarean section of pregnancy-induced hypertension patients

目的:探讨右美托咪定联合盐酸氢吗啡酮对妊娠高血压综合征(妊高征)患者剖宫产术后硬膜外自控镇痛的效果和循环的影响.方法:90例择期行剖宫产术妊高征患者,随机分为3组:氢吗啡酮6 mg(H6组),右美托咪定+氢吗啡酮4 mg(H4组),吗啡4 mg(M组),每组30例.3组均采用腰麻与硬膜外联合麻醉,术后给予病人自控硬膜外镇痛(PCEA)镇痛,PCEA容量及参数设置相同.记录术前(T0)、术后4 h(T4)、8 h(T8)、12 h(T12)、24 h(T24)、36 h(T36)、48 h(T48)各时间点的平均动脉压(MAP)、心率(HR)、呼吸(R)、脉搏血氧饱和度(SpO2)、Ramsay镇静评分(RSS)、视觉模拟镇痛评分(VAS),舒适度评分(BCS)等,记录术后48 h追加补充镇痛药的种类、次数以及术后恶心、呕吐、皮肤瘙痒等不良反应的发生情况,记录血管活性药物的使用情况及患者的舒适度.结果:术后H6和H4组的MAP、HR低于M组,差异有统计学意义(P<0.05);3组的VAS评分和呼吸频率无统计学差异(P>0.05);3组患者的Ramsay评分和BCS评分从T12后组间比较差异有统计学意义(P<0.05);术后H6和H4组胃肠蠕动的恢复比M组快(P<0.05);H6组和H4组不良反应发生率低于M组(P<0.05);3组都没有追加阿片类镇痛药.结论:术后联合盐酸氢吗啡酮4 mg和右美托咪定每小时每千克0.15μg硬膜外腔泵注,能有效治疗妊高征患者剖宫产术后急性疼痛,维护循环稳定,术后不良反应少,改善了产妇产后的舒适度.

Objective:To investigate influence of dexmedetomidine combined with hydromorphine on patients self-controlled epidural analgesia and circulation after cesarean section in pregnancy-induced hypertension patients.Methods:Total number of 90 pregnancy-induced hypertension patients received cesarean section were randomly divided into three groups(30 cases in each group):Group H6,Group H4 and Group M.All groups received combined spinal epidural anesthesia,and then they were offered PCEA for pain management with same volume as well as same pump setting pattern.Mean arterial pressure(MAP),heart rate(HR),respiratory rate and pulse oxygen saturation were recorded before the operation(T0).After 4 hours(T4),8 hours(T8),12 hours(T12),24 hours(T24),36 hours(T36)and 48 hours(T48)of the operation,Ramsay sedation score(RSS)and visual analogue scale(VAS)score were recorded in all time points.Records were also made 48 hours after the operation including additional remedial analgesics types and adverse reactions such as nausea,emesis,pruritus,the application of vasoactive drugs,and patients satisfaction degree.Results:The H6 group and H4 group had lower MAP and HR than the M group(P<0.05)in post-operation while their VAS score and respiratory rate had no statistical significance(P>0.05).After T12,there are statistically significant difference of Ramsay score and BCS score between three groups.Post-operative recovery of gastrointestinal peristalsis in the H6 and H4 groups were faster than the M group(P<0.05).The incidence of adverse reactions in H6 group and H4 group was lower than that in M group(P<0.05).Besides,no additional remedial analgesics case was observed.Conclusion:Pumping combination of hydromorone hydrochloride 4 mg with dexmedetomidine 0.15 g/kg/h into epidural space can effectively treat patients with acute pain after cesarean section,maintained stable circulation,reduced post-operative adverse reactions,and improved maternal comfort.