右美托咪定在程控硬膜外间歇脉冲输注下辅助分娩镇痛的适宜浓度

The optimal concentration of dexmedetomidine for assisted labor analgesia under program-controlled intermittent epidural bolus

目的探讨右美托咪定复合罗哌卡因在程控硬膜外间歇脉冲注入(programmed intermittent epidural bolus, PIEB)模式下应用于分娩镇痛的适宜浓度。方法选择2018年10月至2019年10月在四川锦欣妇女儿童医院有分娩镇痛要求的足月初产妇160例,随机分为4组,每组40例(D1、D2、D3、D4组:0.2 ug/mL、0.3 ug/mL、0.4 ug/mL、0.5 ug/mL右美托咪定+0.08%罗哌卡因)。硬膜外穿刺成功并确认导管位置后,连接相应PIEB镇痛泵。记录镇痛期间生命体征、宫缩疼痛视觉模拟评分(visual analogue scale, VAS)、Ramsay镇静评分、运动阻滞改良Bromage评分;记录镇痛起效时间、第1次追加药物时间、患者自控镇痛(patient-controlled analgesia, PCA)按压次数、补救镇痛次数、镇痛药物用药总量、产程时间、催产素使用率、分娩方式和脐动脉血气、新生儿Apgar评分;记录不良反应的发生情况和产妇满意度。结果 4组产妇镇痛后VAS评分明显低于镇痛前,镇痛后D1组的VAS评分明显高于D2、D3、D4组(P<0.05)。第1次追加药物时间D1组[(248±69)min]明显短于D2[(318±71)min]、D3[(325±58)min]、D4组[(341±80)min],PCA按压比例D1(67%)组明显高于D2(31%)、D3(24%)、D4(16%)组(P<0.05)。4组产妇产科情况、新生儿情况以及不良反应比较差异无统计学意义(P>0.05)。D1、D2、D3组无运动阻滞发生,D4组有2例发生运动阻滞。结论联合0.08%的罗哌卡因在PIEB模式下应用于分娩镇痛时,右美托咪定浓度在0.3~0.4 ug/mL镇痛效果好,浓度相对适宜。

Objective To explore the appropriate concentration of dexmedetomidine combined with ropivacaine for labor analgesia under the mode of programmed intermittent epidural bolus(PIEB).Methods 160 nulliparous parturients in Sichuan Jinxin Women and Children’s Hospital form October 2018 to October 2019 were randomly assigned to one of the four groups(Groups D1,D2,D3,and D4 received 0.2,0.3,0.4,and 0.5 ug/mL of dexmedetomidine+0.08% ropivacaine),40 cases in each group.After successful epidural puncture and confirmation of catheter position, the corresponding PIEB analgesia pump was connected.The onset time of analgesia, the time of the first addition of analgesia, the number of PCA compressions, the number of remedial analgesia, the total amount of analgesic drugs, the duration of labor, Oxytocin use rate, the mode of delivery, umbilical artery blood gas, and the Apgar score of neonates were recorded.Adverse reactions and maternal satisfaction were recorded.Results VAS scores in the four groups were significantly lower than those before analgesia, and VAS scores in the D1 group were significantly higher than those in the D2,D3 and D4 groups(P<0.05).The time of the first drug addition in group D1[(248±69)min] was significantly shorter than that in group D2[(318±71)min],D3[(325±58)min] and D4[(341±80)min],and the PCA compression ratio in group D1(67%) was significantly higher than that in group D2(31%),D3(24%) and D4(16%)(P<0.05).There were no significant differences in maternal obstetrics, neonatal conditions, and adverse reactions between the four groups(P>0.05).No motor block occurred in group D1,D2 and D3,and 2 cases occurred in group D4.Conclusion Combined with 0.08% ropivacaine, dexmedetomidine concentration at 0.3~0.4 ug/mL has a good analgesic effect and a relatively appropriate concentration when applied to labor analgesia under PIEB.