右美托咪定复合罗哌卡因应用于分娩镇痛的适宜硬膜外输注模式探讨

Study on Appropriate Epidural Infusion Mode of Dexmedetomidine Combined with Ropivacaine foRLaboRAnalgesia.

目的通过观察程控硬膜外间歇脉冲注入模式和持续硬膜外输注模式,联合硬膜外自控镇痛用于分娩镇痛的效果,探讨右美托咪定复合罗哌卡因用于分娩镇痛的适宜硬膜外输注模式。方法选择要求行分娩镇痛的足月初产妇120例,随机分为程控硬膜外间歇脉冲注入组(PIEB组)和持续性硬膜外输注组(CEI组),每组各60例。宫口开至2~3 cm时,实施持续性硬膜外镇痛,并连接相应自控镇痛泵。PIEB组:首次剂量10 ml,脉冲剂量8 ml/h;CEI组:首次剂量10 ml,持续背景剂量8 ml/h。镇痛泵配置均为:(0.8 mg/ml罗哌卡因+0.4μg/ml右美托咪定)150 ml,两组均设置PCEA剂量8 ml,锁定时间20 min。观察镇痛镇静效果、产程、分娩方式、脐动脉血气以及新生儿Apgar评分等。结果两组分娩镇痛后都取得良好的镇静镇痛效果,PIEB组宫口开全时VAS评分明显低于CEI组(P<0.05),且PCEA使用率明显低于CEI组(P<0.05);产程时长、分娩方式、用药总量等比较差异均无统计学意义(P>0.05);两组胎儿脐动脉血气pH、BE值以及新生儿Apgar评分比较差异均无统计学意义(P>0.05)。结论程控硬膜外间歇脉冲注入模式联合硬膜外自控镇痛,是右美托咪定复合罗哌卡因应用于分娩镇痛的适宜输注模式,镇痛效果更好,满意度更高。

Objective To observe the effect of programmed intermittent epidural bolus mode and continuous epidural infusion mode combined with patient-controlled epidural analgesia for labor analgesia,and to explore the appropriate epidural infusion mode of dexmedetomidine combined with ropivacaine for labor analgesia.Methods A total of 120 full-term primiparae who required labor analgesia were randomly divided into two groups(n=60):PIEB group and CEI group.When the uterine orifice opened to 2~3 cm,continuous epidural analgesia was performed,and the corresponding self-controlled analgesia pump was connected.PIEB group:initial dose was 10 ml,pulse dose was 8 ml/h;CEI group:initial dose of 10ml,continuous background dosewas 8ml/h.The analgesic pump configuration was:(0.8 mg/ml ropivacaine+0.4μg/ml dexmedetomidine)150 ml,the PCA dose of 8 ml was set for both groups,and the lock time was 20 min.The analgesic and sedative effect,labor course,delivery mode,umbilical artery blood gas and the Apgar score of newborns were observed.Results Both groups achieved good sedative and analgesic effects after labor analgesia.The VAS score at full time of uterine opening in PIEB group was significantly lower than that in CEI group(P<0.05),and the utilization rate of PCEA was significantly lower than that in CEI group(P<0.05).There was no significant difference in labor duration,delivery mode and total amount of medication(P>0.05).There was also no significant difference in pH,BE and Apgar score of fetal umbilical artery blood gas between the two groups(P>0.05).Conclusion Programmed intermittent epidural bolus mode combined with patient-controlled epidural analgesia is a suitable infusion mode of dexmedetomidine combined with ropipiaine for labor analgesia,with better analgesic effect and higher satisfaction.