右美托咪定复合罗哌卡因硬膜外注射对先兆子痫产妇分娩镇痛的影响

Effects of epidural dexmedetomidine combined with ropivacaine on labor analgesia in parturients with preeclampsia

目的观察右美托咪定复合罗哌卡因硬膜外注射对先兆子痫产妇分娩镇痛的影响。方法将80例先兆子痫且自愿接受分娩镇痛的产妇随机均分为对照组和右美托咪定组。硬膜外穿刺成功后,对照组和右美托咪定组分别经硬膜外导管注入0.125%罗哌卡因10 m L和含右美托咪定0.5μg·kg-1的0.125%罗哌卡因10 m L。感觉阻滞平面达T10后, 2组均采用0.125%罗哌卡因开始患者自控硬膜外镇痛。观察镇痛镇静效果、分娩情况、新生儿Apgar评分,检测产妇血浆肾上腺素和去甲肾上腺素浓度,并记录产妇生命体征和不良反应发生情况。结果右美托咪定组镇痛后30 min (T1)、 60 min (T2)、 120 min (T3)和停止镇痛(T4)时Ramsay镇静评分均高于对照组(P <0.05), T1、 T2时疼痛视觉模拟量表(VAS)评分低于对照组(P <0.05)。右美托咪定组第二产程时间短于对照组(P <0.05), 2组第一产程时间、产钳率和新生儿娩出后1 min Apgar评分比较均无显著差异(P> 0.05)。T2时右美托咪定组血浆肾上腺素、去甲肾上腺素浓度低于对照组(P <0.05)。右美托咪定组T1、 T4时平均动脉压低于对照组, T2~T4时心率低于对照组,差异均有显著意义(P <0.05)。2组均无严重不良反应发生,不良反应发生率组间比较无显著差异(P> 0.05)。结论右美托咪定复合罗哌卡因硬膜外注射用于先兆子痫产妇分娩镇痛,其镇痛过程完善,镇静效果好,对产妇和新生儿均安全。

AIM To investigate the effects of epidural dexmedetomidine combined with ropivacaine on labor analgesia in parturients with preeclampsia.METHODS Eighty parturients with preeclampsia were randomly divided into control group(group C,n=40)and dexmedetomidine group(group D,n=40).After success of epidural puncture,patients in the group C received epidural 0.125%ropivacaine 10 mL for labor analgesia,whereas patients in the group D received epidural 0.125%ropivacaine 10 mL with dexmedetomidine 0.5μg·kg-1 in addition.After the sensory block level reached T10,0.125%ropivacaine was used to initiate patient-controlled epidural analgesia in both groups.The effects of analgesia and sedation,delivery course and Apgar score of neonates were observed,and the plasma concentrations of epinephrine and norepinephrine were measured.The adverse reactions and vital signs of parturients were recorded.RESULTS The Ramsay scores at 30 min(T1),60 min(T2),120 min(T3)after labor analgesia and at the moment of complete cervical dilatation(T4)were significant higher in the group D than those in the group C(P<0.05).The VAS scores of pain at T1 and T2 were significant lower in the group D than those in the group C(P<0.05).The duration of second labor stage was shorter in the group D than those in the group C(P<0.05).There were no significant differences between the two groups in the duration of first labor stage,the incidence of forceps and Apgar score 1 min after delivery(P>0.05).The plasma concentrations of epinephrine and norepinephrine at T2 were significant lower in the group D than those in the group C(P<0.05).The mean arterial pressure at T1 and T4 were significant lower in the group D than those in the group C(P<0.05).The heart rate at T2-T4 were significant lower in the group D than those in the group C(P<0.05).No serious adverse reactions occurred in the two groups,and there were no significant differences in the incidence of adverse reactions between two groups(P>0.05).CONCLUSION By using epidural dexmedetomidine combined with ropivacaine on labor analgesia in parturients with preeclampsia,the analgesia process is perfect,with good sedative effect and antihypertensive effect,and it is safe for the women and the newborn.