右美托咪定联合利多卡因硬膜外分娩镇痛对母婴结局及血清ALD、NE、Cor的影响

The effects of dexmedetomidine combined with lidocaine for epidural analgesia in labor on maternal and infant outcomes and serum aldosterone,norepinephrine,cortisol

目的探究右美托咪定联合利多卡因硬膜外分娩镇痛对母婴结局及血清醛固酮(ALD)、去甲肾上腺素(NE)、皮质醇(Cor)的影响。方法选取行硬膜外分娩镇痛的240例产妇,将其按照随机数字表法分为联合组和单一组,各120例。其中单一组给予1%利多卡因硬膜外镇痛,联合组给予右美托咪定联合1%利多卡因硬膜外镇痛。比较两组血清ALD、NE、Cor水平,产程时间,疼痛程度,分娩结局及母婴结局。结果宫口开全、胎儿娩出时联合组血清ALD、NE、Cor水平与单一组比较均明显降低(P<0.05),第一、二、三产程时间与单一组比较均明显缩短(P<0.05)。干预后,两组产妇VAS评分与干预前相比均明显降低(P<0.05),且联合组与单一组比较明显降低(P<0.05)。联合组阴道分娩率91.67%与单一组70.83%比较明显升高(P<0.05),阴道助产率、剖宫产率、新生儿不良结局发生率及产妇不良结局发生率分别为6.67%、1.67%、0.00%、1.67%与单一组20.83%、8.33%、6.67%、8.33%比较均明显降低(P<0.05)。结论右美托咪定联合利多卡因硬膜外镇痛可有效降低产妇血清ALD、NE、Cor水平,抑制应激反应,缩短产程,改善母婴结局及分娩结局,值得临床推广使用。

Objective To investigate the effects of dexmedetomidine combined with lidocaine epidural analgesia in labor on maternal and infant outcomes and serum aldosterone(ALD),norepinephrine(NE),and cortisol(Cor).Methods A total of 240 parturients undergoing epidural analgesia in labor in our hospital were selected and divided into combined group and single group according to the random number table,with 120 cases in each group.The single group was given with 1%lidocaine epidural analgesia,while the combined group was given dexmedetomidine combined with 1%lidocaine epidural analgesia.The serum ALD,NE,Cor levels,labor process time,pain degree,delivery outcome and maternal and infant outcomes were compared between the two groups.Results The levels of serum ALD,NE and Cor in the combined group were significantly lower than those in the single group when the cervix was fully opened and the fetus was delivered(P<0.05);and the first,second and third stages of labor were significantly shorter than those in the single group(P<0.05).After the intervention,the VAS scores of the two groups were significantly lower than those before the intervention(P<0.05),and the VAS score in the combined group was significantly lower than that in the single group(P<0.05).The vaginal delivery rate of the combined group was 91.67%,which was significantly higher than that of the single group(70.83%,P<0.05).The rates of vaginal delivery,cesarean section,neonatal adverse outcomes and maternal adverse outcomes in the combined group were 6.67%,1.67%,0.00%and 1.67%,respectively,which were significantly lower than those in the single group(20.83%,8.33%,6.67%and 8.33%,respectively,P<0.05).Conclusion Dexmedetomidine combined with lidocaine epidural analgesia can effectively reduce maternal serum ALD,NE,Cor levels,inhibit stress response,shorten the labor process,improve maternal and infant outcomes and delivery outcomes.