不同浓度右美托咪定联合舒芬太尼辅助罗哌卡因对分娩镇痛的效果分析

Labor analgesia effect of dexmedetomidine at varying concentrations combined with sufentanil in assisting ropivacaine

目的探讨不同浓度右美托咪定联合舒芬太尼辅助罗哌卡因用于分娩镇痛的效果。方法选取2020年9月至2021年9月分娩产妇作为研究对象,将符合纳入标准的160例分娩产妇,按随机数字表分为4组,硬膜外镇痛联合生理盐水组(N组)、硬膜外镇痛联合静脉泵注右美托咪定0.5μg/kg组(D1组)、硬膜外镇痛联合静脉泵注右美托咪定0.75μg/kg组(D2组)和硬膜外镇痛联合静脉泵注右美托咪定1μg/kg组(D3组),每组40例;观察4组不同时间点疼痛情况、母婴状况,应用RT-PCR及Western Blot方法检测胎盘中Raf、ERK、CREB及DYN的mRNA及蛋白表达水平。结果疼痛情况:镇痛前,4组VAS评分比较差异无统计学意义(P>0.05),宫口开7~8 cm、宫口开全时各组VAS评分比较差异有统计学意义(P<0.05),其中N组VAS评分最高,D3组VAS评分最低(P<0.05),D2组、D3组之间VAS评分比较差异无统计学意义(P>0.05)。产妇状态:4组产程时间差异有统计学意义(P<0.05),其中N组产程时间最长,D1组、D2组、D3组之间产程时间比较差异无统计学意义(P>0.05);各组产后2 h阴道出血量比较差异无统计学意义(P>0.05)。新生儿状态:4组新生儿Apgar评分、新生儿脐动脉血气(pH值、PO_(2)、PCO_(2))比较差异无统计学意义(P>0.05)。4组胎盘组织ERK信号分子及效应分子mRNA及蛋白表达水平:4组胎盘组织Raf、ERK、CREB、DYNmRNA及蛋白表达水平比较差异有统计学意义(P<0.05),与N组相比,D1组、D2组、D3组Raf、ERK及CREBmRNA表达、蛋白表达均降低(P<0.05);D3组Raf、ERK及CREBmRNA表达、蛋白表达水平最低,DYNmRNA、蛋白表达水平最高,但与D2组比较差异无统计学意义(P>0.05)。结论0.75μg/kg右美托咪定联合舒芬太尼辅助罗哌卡因用于分娩镇痛中,可缓解疼痛、缩短产程时间,且不会影响新生儿状态。

Objective To investigate the labor analgesia effect of dexmedetomidine at varying concentrations combined with sufentanil in assisting ropivacaine.Methods From September 2020 to September 2021,160 eligible puerperae who delivered in our hospital were randomly allocated to 4 groups,including epidural analgesia combined with normal saline group(group N),epidural analgesia combined with intravenous pumping of dexmedetomidine 0.5μg/kg group(group D1),epidural analgesia combined with intravenous pumping of dexmedetomidine 0.75μg/kg group(D2 group)and epidural analgesia combined with intravenous pumping of dexmedetomidine 1μg/kg group(D3 group),with 40 cases in each group.The pain conditions and maternal and infant conditions in each group were observed at different time points.The mRNA and protein expressions of Raf,extracellular signal-regulated kinase(ERK),cAMP response element binding-protein(CREB)and dynorphin(DYN)in the placenta were detected by reverse transcription-polymerase chain reaction(RT-PCR)and Western Blot,respectively.Results(1)Pain condition:Before analgesia,there was no significant difference in the Visual Analogue Scale(VAS)scores among the four groups(P>0.05).A significant difference in VAS scores was detected among the four groups at the time points of 7-8cm dilation and 100%dilation(P<0.05),among which,group N and D3 graded the highest and lowest VAS scores,respectively(P<0.05).There was no significant difference in VAS scores at the time points of 7~8 cm dilation and 100%dilation between group D2 and D3(P>0.05).(2)Maternal status:There was a significant difference in labor time among the four groups(P<0.05),among which,group N had the longest labor time,which was comparable among group D1,group D2 and group D3(P>0.05).There was no significant difference in the amount of vaginal bleeding in each group at 2h postpartum(P>0.05).(3)Neonatal status:There were no significant differences in the neonatal Apgar score,pH level,partial pressure of oxygen(PO_(2))and partial pressure of carbon dioxide(PCO_(2))in neonatal umbilical artery blood among the four groups(P>0.05).(4)The mRNA and protein expressions of ERK signal molecules and effector molecules in placenta of each group:There were significant differences in mRNA and protein expressions of Raf,ERK,CREB and Dyn in placenta of each group(P<0.05).Compared with those in group N,the mRNA and protein expressions of Raf,ERK and CREB in group D1,group D2 and group D3 were all significantly lower(P<0.05).The mRNA and protein expressions of Raf,ERK and CREB in group D3 were the lowest,while that of DYN was the highest.Their expression levels were comparable between group D3 and group D2(P>0.05).Conclusion Dexmedetomidine 0.75μg/kg combined with sufentanil in assisting ropivacaine for labor analgesia can relieve pain,and shorten labor time,which do not affect neonatal status.