右美托咪定复合酒石酸布托啡诺联合硬膜外镇痛用于产妇分娩镇痛的效果

Effect of Dexmedetomidine Combined with Butorphanol Tartrate Combined with Epidural Analgesia on Labor Analgesia

目的观察右美托咪定复合酒石酸布托啡诺联合硬膜外镇痛用于产妇分娩镇痛的效果。方法选取2019年1—12月沧州市人民医院共188例单胎足月初产妇,按随机数表法分为A组和B组,每组各94例。A组进入规律宫缩时使用右美托咪定复合酒石酸布托啡诺经静脉患者自控镇痛(patient controlled intravenous analgesia,PCIA)泵输注,B组进入规律宫缩时只用酒石酸布托啡诺PCIA泵输注,待宫口开到3 cm时停用PCIA泵,同时接受硬膜外分娩镇痛。对比两组孕妇生产中的产程、平均动脉压(mean arterial pressure,MAP)、呼吸频率(respiratory rate,RR)、心率(heart rate,HR)以及脉搏血氧饱和度(pulse oxygen saturation,SpO_(2))、宫缩压力以及胎儿HR,对比PCIA前后静息视觉模拟评分(visual analogue scale,VAS)及ICU常用镇静镇痛评分(RASS),对比两组新生儿Apgar评分。结果A组第一产程与第二产程时间低于B组(P均<0.05);A组第三产程与B组差异无统计学意义(P>0.05);镇痛前两组患者VAS评分及RASS评分对比差异均无统计学意义(P均>0.05);镇痛后A组VAS评分及RASS评分均低于B组(P均<0.05);重复测量分析显示,两组MAP、RR、HR、SpO_(2)主体内效应、主体间效应比较差异均有统计学意义(P均<0.05)。简单效应LSD-t成对比较显示,A组在T0、T1时MAP高于B组、RR低于B组(P均<0.05);重复测量分析显示,两组产妇宫缩频率、宫缩强度、宫缩压力、胎儿心率主体内效应、主体间效应比较差异均有统计学意义(P均<0.05)。简单效应LSD-t成对比较显示,A组t0、t1时胎儿心率低于B组(P均<0.05);两组新生儿Apgar评分对比差异无统计学意义(P>0.05);两组不良反应总发生率对比差异无统计学意义(P>0.05)。结论产妇分娩过程中使用右美托咪定复合酒石酸布托啡诺镇痛可有效减轻产妇疼痛、缩短产程。

Objective To observe the effect of dexmedetomidine combined with butorphanol tartrate combined with epidural analgesia for maternal labor analgesia.Methods From January 2019 to December 2019,188 full-term primiparas with singleton in Cangzhou People's Hospital were selected and randomly divided into group A and group B with 94 cases in each group.Group A was infused with dexmedetomidine combined with butorphanol tartrate by intravenous patient-controlled analgesia(PCIA)pump when entering regular uterine contraction.Group B was infused with physiological saline PCIA pump when entering regular uterine contraction.When the uterine opening was 3 cm,the PCIA pump was stopped and epidural labor analgesia was received.The duration of labor,mean arterial pressure(MAP),respiratory rate(RR),heart rate(HR),pulse oxygen saturation(SpO_(2)),contractions pressure and fetal heart rate were compared between the two groups.The rest visual analogue scale(VAS)and the commonly used sedation and analgesia score(RASS)in ICU before and after PCIA were compared.The Apgar score of newborns in the two groups was compared.Results The time of the first and second stage of labor in group A was significantly lower than that in group B(P all<0.05).There was no significant difference in the third stage of labor between group A and group B(P>0.05).There was no significant difference in VAS score and RASS score between the two groups before analgesia(P all>0.05).After analgesia,VAS score and RASS score in group A were significantly lower than those in group B(P all<0.05).Repeated measurement analysis showed that there were significant differences in MAP,RR,HR,SpO_(2) intra subject effect and inter subject effect between the two groups(P all<0.05).The paired comparison of simple effect LSD-t showed that MAP in group A was significantly higher than that in group B at T0 and T1,and RR was significantly lower than that in group B(P all<0.05).Repeated measurement analysis showed that there were significant differences in uterine contraction frequency,uterine contraction intensity,uterine contraction pressure,intra subject effect and inter subject effect between the two groups(P all<0.05).The paired comparison of simple effect LSD-t showed that the fetal heart rate at t0 and t1 in group A was significantly lower than that in group B(P all<0.05).There was no significant difference in Apgar score between the two groups(P>0.05).There was no significant difference in adverse reactions between the two groups(P>0.05).Conclusion The use of right metomidine and butorphanol tartrate in the parturient delivery can effectively reduce the pain and shorten the labor process.