不同剂量右美托咪定联合羟考酮对剖宫产术后镇痛效果及泌乳影响

Influence of different doses of dexmedetomidine combined with oxycodone on postoperative analgesic effect and lactation in women with cesarean section

目的:分析不同剂量右美托咪定联合羟考酮对剖宫产术后镇痛效果及对泌乳影响。方法:选取2018年1月-2020年12月在本院行剖宫产术产妇162例,随机数字表法分为高、中、低剂量组各54例,分别按照0.3ug、0.4、0.5ug/kg/h剂量的右美托咪定联合0.4mg/kg羟考酮术后镇痛,观察各组术后30min(T0)、1h(T1)、2h(T2)、4h(T3)、8h(T4)、12h(T5)、24h(T8)、48h(T7)的Ramsay镇静评分和VAS疼痛评分;比较两组术前及术后24h、48h、72h血清泌乳素(PRL)水平及首次泌乳时间,术后不良反应情况。结果:镇静效果,T0、T1、T2、T3、T4、T5、T6、T7时刻Ramsay评分高、中、低剂量组依次(P<0.05)。镇痛效果,T0、T1、T2时刻高剂量组和中剂量组VAS评分均低于低剂量组(P<0.05),其余时刻3组VAS评分无差异(P>0.05)。术后24h、48h、72h血清PRL水平及首次泌乳时间均高、中剂量组无差异但高于低剂量组(P<0.05)。镇痛期间低剂量组恶心发生率(14.0%)高于另外两组,高剂量组低血压(13.0%)、心动过缓(16.7%)发生率高于另外两组(P<0.05),呕吐、头晕、镇静过度发生率3组无差异(P>0.05)。结论:0.4μg/kg/h右美托咪定联合0.4mg/kg羟考酮用于剖宫产术后镇痛镇静效果确切,有助于提升产妇产后血清PRL水平,缩短首次泌乳时间,不良反应发生率低,临床应用安全性高。

Objective:To analyze the influence of different doses of dexmedetomidine combined with oxycodone for analgesia of women after cesarean section on their analgesic effect and lactation.Methods:162 pregnant women who wanted cesarean section were included as the research objects,and were divided into group A,B,and C(54 cases in each group)by random number table from January 2018 to December 2020.The women in group A,B,and C were treated with 0.3ug/kg.h,0.4ug/kg.h,and 0.5ug/kg.h of dexmedetomidine combined with 0.4mg/kg oxycodone for postoperative analgesia,respectively.Ramsay sedation score(RSS)and visual analog pain score(VAS)at 30min(T0),1h(T1),2h(T2),4h(T3),8h(T4),12h(T5),24h(T8),and 48h(T7)after cesarean section of the women in the three groups were observed.The serum prolactin(PRL)level before and postoperative 24h,48h,and 72h,the time of first lactation after cesarean section,and postoperative adverse reactions rate of the women were compared among the three groups.Results:As for sedative effect,Ramsay score of the women in group C,B and D at T0,T1,T2,T3,T4,T5,T6 and T7 had decreased in turn(P<0.05).As for analgesic effect,VAS scores of the women in group C and C at T0,T1,and T2 were significant lower than those of the women in group A(P<0.05),but VAS scores of the women at T3,T4,T5,T6,and T7 had no significant difference among the three groups(P>0.05).The serum PRL level and the first lactation time of the women in group C and B at 24h,48h and 72h after surgery had no significant difference,but which were all significant higher than those of the women in group A(P<0.05).During analgesia,the incidences of nausea(14.0%),hypotension(13.0%),and bradycardia(16.7%)of the women in group A were significant higher than those of the women in the other two groups(P<0.05),but there were no significant differences in the incidences of vomiting,dizziness,and oversedation of the women among the three groups(P>0.05).Conclusion:0.4ug/kg.h of dexmedetomidine combined with 0.4mg/kg of oxycodone for analgesia of women after cesarean section has exact effectiveness,which helps to increase the level of maternal postoperative serum prolactin,shorten the first lactation time,and reduce the incidence of adverse reactions with high safety in clinic.