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、睡眠质量的比较

The comparison of effect of different doses of dexmedetomidine combined with tramadol on intravenous analgesia and sleep quality 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的效果及其对睡眠质量的影响。方法:选择2019年3月至2020年7月广东省中山市博爱医院收治的120例行剖宫产术的产妇为研究对象,按随机数字表法分为四组,每组30例,A组在剖宫产术后予以800 mg曲马多+5 mg托烷司琼镇痛,B1、B2、B3组在A组基础上联合右美托咪定,剂量分别为1.0、1.5、2.0μg/kg。观察四组术后6、12、24、48 h运动、静息时视觉模拟量表(VAS)评分,手术前后阿森斯失眠量表(AIS)评分,四组术后6、12、24、48 h Ramsay镇静评分及基础生命体征指标,记录四组术后48 h内的不良反应发生率。结果:四组术后6、12、24 h运动、静息状态VAS评分比较差异有统计学意义(P<0.05),其中A组运动、静息状态VAS评分最高,其次为B1、B2、B3组。四组术后第1、2天AIS评分比较差异有统计学意义(P<0.05),其中A组AIS评分最高,其次为B1、B2、B3组。四组术后6、12、24、48 h脉搏血氧饱和度(SpO 2)水平比较差异无统计学意义(P>0.05)。四组术后6、12、24 h收缩压(SBP)、舒张压(DBP)、心率(HR)水平比较差异有统计学意义(P<0.05),其中A组SBP、DBP、HR水平最高,其次为B1、B2、B3组,A、B1、B2组各时间点SBP、DBP、HR均在正常范围内,B3组术后6 h的SBP、DBP接近正常值下限,且部分患者HR低于正常值。四组术后6、12、24、48 h Ramsay镇静评分比较差异有统计学意义(P<0.05),其中A组术后6、12、24、48 h Ramsay镇静评分最低,其次为B1、B2、B3组。四组不良反应发生率比较差异有统计学意义(χ2=10.719,P=0.013),其中B3组不良反应总发生率最高[33.33%(10/30)],B1组最低[6.67%(2/30)]。结论:中剂量右美托咪定(1.5μg/kg)配伍曲马多对剖宫产患者术后静脉镇静镇痛效果较好,能提高患者睡眠质量,且用药安全性能得到保障。

Objective To investigate the effects of different doses of dexmedetomidine combined with tramadol on intravenous analgesia and sleep quality after cesarean section.Methods One hundred and twenty pregnant women who underwent cesarean section in Zhongshan Boai Hospital from March 2019 to July 2020 were selected.They were randomly divided into four groups,with 30 patients in each group.The patients in group Awere given patient controlled anesthesia with tramadol 800 mg+tropisetron 5mg after cesarean section,and the patients in group B1,B2 and B3 were given 1.0,1.5,2.0μg/kg dexmedetomidine on the basis of group A.The scores of exercise and rest of visual analogue scale(VAS)at 6,12,24 and 48 h after the surgery were observed.The scores of Athens insomnia scale(AIS)before and after surgery were compared.The Ramsay sedation scores and basic vital signs were recorded,compared and analyzed at 6,12,24 and 48 h after the surgery.The incidence of adverse reactions within 48 h after the surgery was counted in the four groups.Results The scores of exercise and rest of VAS at 6,12,24 and 48 h after the surgery in four groups had significant differences(P<0.05).The scores of group A were the highest,and next were the group B1,B2 and B3.The scores of AIS at 1 and 2 d after surgery in four groups had significant differences(P<0.05).The scores of group A were the highest,and next were the group B1,B2 and B3.The level of oxyhemoglobin saturation(SpO2)after surgery in four groups had no significant difference(P>0.05).The levels of systolicblood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)after surgery in four groups had significant differences(P<0.05).The levels of SBP,DBP,HR in group A were the highest,and next were the group B1,B2 and B3.Thelevels of SBP,DBP,HR in group A,B1 and B2 were in normal range,but the levels of SBP,DBP and HR in group B3 were in lower limits of normal,the level of HR in some patients was below normal.The Ramsay sedation scores at 6,12,24 and 48 h after surgery in the four groups had significant differences(P<0.05).Ramsay sedation scores in group A were the lowest,and next were the group B1,B2 and B3.The total incidence of adverse reactions in group B3 was the highest with 33.33%(10/30),and in group B1 was the lowest with 6.67%(2/30).Conclusions Medium dose of dexmedetomidine(1.5μg/kg)combined with tramadol has a good effect on postoperative intravenous sedation and analgesia in patients after cesarean section,which can improve the sleep quality of patients.Besides,the drug safety can be guaranteed.