右美托咪定对剖宫产术后舒芬太尼静脉自控镇痛效果的影响

Effect of dexmedetomidine combined with sufentanil for intravenous patient-controlled analgesia after caesarean section

目的观察剖宫产术后右美托咪定复合舒芬太尼静脉自控镇痛的效果。方法 2015年1~6月60例剖宫产手术产妇采用随机数字表法分为S组和D组,每组30例。S组术毕应用舒芬太尼2.5μg/kg、托烷司琼10 mg静脉镇痛;D组术毕应用右美托咪定4μg/kg、舒芬太尼2.5μg/kg、托烷司琼10 mg静脉镇痛。采用视觉模拟评分(VAS)和Ramsay镇静评分(RSS),观察两组产妇术后镇痛、镇静效果。记录术后4 h、8 h、12 h、24 h新生儿神经适应能力(NACS)评分,并观察术后产妇的血浆催乳素浓度、肠蠕动恢复时间和镇痛期间可能出现的不良反应。结果在术后4 h、8 h、12 h、24 h,D组产妇镇痛评分[(2.6±0.8)分、(3.4±0.8)分、(3.4±0.7)分、(3.1±0.6)分]和镇静评分[(2.4±0.7)分、(2.5±0.6)分、(2.5±0.5)分、(2.6±0.5)分]明显优于S组镇痛评分[(3.6±1.0)分、(4.4±1.0)分、(4.4±1.0)分、(3.9±0.7)]分和镇静评分[(1.6±0.6)分、(1.5±0.4)分、(1.5±0.5)分、(2.1±0.5)分],两组比较差异有统计学意义(Р<0.05)。两组新生儿术后4 h[(36.6±1.0)分vs(37.3±1.9)分]、8 h[(37.1±1.3)分vs(37.6±1.7)分]、12 h[(37.5±1.3)分vs(36.8±1.7)分]、24 h[(38.2±0.9)分vs(37.9±1.5)分]的NACS评分、血浆催乳素浓度[(353.7±82.7)μIU/m L vs(361.1±97.6)μIU/m L]、肠蠕动恢复时间[(17.5±7.6)h vs(15.7±8.1)h]的比较差异也无统计学意义(P>0.05)。S组呕吐发生率[26.7%(8/30)]高于D组[3.3%(1/30)],但恶心[26.7%(8/30)vs 10.0%(3/30)]、头晕[26.7%(8/30)vs 33.3%(10/30)]、寒颤[16.7%(5/30)vs3.3%(1/30)]、口干[10.0%(3/30)vs 20.0%(6/30)]等不良反应比较差异无统计学意义(Р>0.05)。两组均无低血压、心动过缓及呼吸抑制发生。结论右美托咪定复合舒芬太尼可有效用于剖宫产术后静脉自控镇痛,对新生儿及母乳喂养无不良影响,且右美托咪定能有效降低阿片类药物的静脉镇痛副作用。

Objective To evaluate the effect of dexmedetomidine combined with sufentanil for intravenous patient-controlled analgesia after caesarean section. Methods From January 2015 to June 2015, sixty parturients scheduled for elective caesarean delivery were randomly assigned into group S and group D according to the random number table method(sealed concealed envelope)(n=30 each). The analgesic solution for group S was sufentanil(2.5 μg/kg)plus tropisetron(10 mg), and that for group D was dexmedetomidine(4 μg/kg), sufentanil(2.5 μg/kg) plus tropisetron(10 mg). The analgesia and sedation efficacy was evaluated by visual analogue scale(VAS) and Ramsay sedation score(RSS). Neonatal neurological and adaptive capacity scores(NACS) were recorded at the 4 h, 8 h, 12 h, 24 h after operation,and the prolactin concentrations, recovery of bowel movement, and adverse effects during analgesia period were observed.Results The VAS [(2.6±0.8),(3.4±0.8),(3.4±0.7),(3.1±0.6)] and the Ramsay sedation score [(2.4±0.7),(2.5±0.6),(2.5±0.5),(2.6±0.5)] of group D at 4 h, 8 h, 12 h, 24 h after operation were better than those of group S [(3.6±1.0),(4.4±1.0),(4.4±1.0),(3.9±0.7),(1.6±0.6),(1.5±0.4),( 1.5±0.5),(2.1±0.5), respectively](Р<0.05).There were no significant differences between two groups in the recovery of bowel movement [(17.5±7.6) h vs(15.7±8.1) h], plasma prolactin level [(353.7±82.7) μIU/m L vs(361.1±97.6) μIU/m L] and neonatal NACS [4 h:(36.6±1.0) vs(37.3±1.9), 8 h:(37.1±1.3) vs(37.6±1.7), 12 h:(37.5±1.3) vs(36.8±1.7), 24 h:(38.2±0.9) vs(37.9±1.5)]. The incidence of vomiting in group S[26.7%(8/30)] was significantly higher than that in group D [3.3%(1/30)](Р<0.05), but there were no significant differences between two groups in nausea [26.7%(8/30) vs 10.0%(3/30)], dizziness [26.7%(8/30) vs 33.3%(10/30)], pruritus [16.7%(5/30) vs 3.3%(1/30)], dry mouth [10.0%(3/30) vs 20.0%(6/30)], shivering and respiration frequency(Р>0.05). There was no bradycardia, hypotension and respiratory depression in two groups. Conclusion The combination of sufentanil and dexmedetomidine for intravenous patient-controlled analgesia after caesarean section can provide an effective analgesia without adverse effects on breast-feeding and NACS, and dexmedetomidine can effectively decrease the adverse effects of opioids drugs for intravenous analgesia.