摘要
目的 观察不同剂量右美托咪定用于剖宫产术后多模式镇痛的效果。方法 选择腰-硬联合麻醉下行剖宫产产妇120例,年龄20~45岁,BMI 20~35 kg/m^(2),ASAⅠ或Ⅱ级,随机分为四组:D_(1)组、D_(2)组、D_(3)组和C组,每组30例。胎儿剖出后,D_(1)组、D_(2)组和D_(3)组产妇15 min内静脉泵注右美托咪定0.5μg/kg,C组予等量生理盐水泵注。所有产妇术后连接自控静脉镇痛(PCIA)泵,镇痛液配方:在氟比洛芬酯4 mg/kg+托烷司琼5 mg基础上,D_(1)组、D_(2)组和D_(3)组分别加入右美托咪定1、2、3μg/kg,C组不加右美托咪定,各组再用生理盐水稀释至100 ml。记录产妇术后6、12、24、48 h VAS疼痛评分、宫缩痛评分、Ramsay镇静评分。记录PCIA有效按压次数、补救镇痛例数及不良反应的发生情况。记录术前和术后泌乳素(PRL)浓度以及术后72 h泌乳量评分。结果 与C组比较,术后12、24、48 h D_(2)组和D_(3)组VAS疼痛评分和宫缩痛评分明显降低(P<0.05),D_(3)组Ramsay镇静评分明显增高(P<0.05)。与C组比较,D_(1)组、D_(2)组和D_(3)组产妇PCIA有效按压次数明显减少(P<0.05),补救镇痛率明显降低(P<0.05),D_(2)组和D_(3)组术后皮肤瘙痒发生率明显降低(P<0.05),D_(3)组术后心动过缓和低血压发生率明显升高(P<0.05),D_(3)组术后PRL浓度和术后72 h泌乳量评分明显升高(P<0.05)。结论 右美托咪定2~3μg/kg复合氟比洛芬酯用于PCIA可以改善剖宫产产妇术后镇痛的效果,促进乳汁分泌,但需警惕心动过缓和低血压的发生。
Objective To observe the effects of different doses of dexmedetomidine in postoperative multimodal analgesia for puerpera after cesarean section.Methods A total of 120 patients,aged 20-45 years,BMI 20-35 kg/m^(2),ASA physical status Ⅰ or Ⅱ,underwent cesarean section under combined spinal and epidural anesthesia were selected.They were randomly divided into four groups:group D_(1),group D_(2),group D_(3) and group C,30 patients in each group.Groups D_(1),D_(2) and D_(3) were given intravenous infusion of 0.5 μg/kg dexmedetomidine in 15 minutes after neonatal removal,and group C was given normal saline infusion of the same amount.Patient-controlled intravenous analgesia(PCIA) were conducted in the four groups after surgery.Analgesic formula:on the basis of fluransetron axetil 4 mg/kg + tolansetron 5 mg,groups D_(1),D_(2) and D_(3) were given dexmedetomidine 1,2 and 3 μg/kg respectively,and group C was not given dexmedetomidine,and all groups were mixed with normal saline to 100 ml respectively.VAS score,contractions pain score,and Ramsay sedation score 6,12,24,and 48 hours after surgery were recorded.Effective pressing times of PCIA,additional analgesia,adverse reactions,preoperative and postoperative prolactin(PRL) values and postoperative lactation score 72 hours after surgery were recorded.ResultsCompared with group C,the VAS score and the contractions pain score in groups D_(2) and D_(3) were significantly decreased(P < 0.05),and Ramsay sedation score in group D_(3) was significantly increased 12,24,and 48 hours after surgery(P < 0.05).Compared with group C,the effective pressing times of PCIA and the analgesic rates in groups D_(1),D_(2) and D_(3) were significantly decreased(P < 0.05);the pruritus incidence in groups D_(2) and D_(3) were decreased significantly(P < 0.05);the incidence of postoperative bradycardia and hypotension in group D_(3) were significantly increased(P < 0.05);the postoperative PRL values and postoperative lactation score 72 hours after surgery in group D_(3) were increased signifi
作者
刘占立
朱丽洁
刘颖
程静
张中军
LIU Zhanli;ZHU Lijie;LIU Ying;CHENG Jing;ZHANG Zhongjun(Department of Anesthesiology,Shenzhen People’s Hospital&the 2nd Clinical Medical College of Jinan University&the First Affiliated Hospital of Southern University of Science and Technology,Shenzhen 518020,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2022年第8期810-814,共5页
Journal of Clinical Anesthesiology
关键词
右美托咪定
术后镇痛
剖宫产术
泌乳素
多模式镇痛
Dexmedetomidine
Postoperative analgesia
Cesarean section
Prolactin
Multimodal analgesia
