国际麻醉学与复苏杂志   2016, Issue (10): 5-5
    
左布比卡因复合右美托咪定在分娩镇痛中的应用 及对母儿的影响
黄岩, 陈宁1()
1.天津市第二医院
The application of Evobupivacaine composite Dexmedetomidine in labor analgesia to influence of mother and son
 全文:
摘要:

[摘 要]目的 研究左布比卡因复合右美托咪定在分娩镇痛中的应用及对母儿的影响。方法 我院分娩的单胎、头位、初产妇120例采用随机数字表法分为两组,观察组应用左布比卡因复合右美托咪定,对照组应用左布比卡因复合舒芬太尼,两组均采用硬膜外麻醉方式。孕妇行硬膜外穿刺,两组分别给予0.1%左布比卡因+0.5μg/ml右美托咪定复合液和0.1%左布比卡因+0.5μg/ml舒芬太尼复合液各5毫升。连接泵镇痛,泵速设置为8ml/h、PCA (Patient Controlled Analgesia) 5ml/次,锁定15min。观察两组产妇生命体征、视觉模拟评分法VAS (Visual Analogue Scale) 评分、Bromage评分、Ramsay评分、产程、产后出血及新生儿Apgar评分。结果 两组产妇血压mm Hg(1 mm Hg=0.133 kPa)心率等在麻醉后30min后(Tb)较麻醉前(Ta)均降低,分别降至10.9±0.62,11.5±0.72和70±9.83,76±8.23,两组比较有差异(P<0.05)。观察组和对照组在(T1)、 (T2)、 (T3)各时点VAS评分分别为1.3±0.7、3.0±0.3、3.0±0.5和1.7±0.6、3.5±0.7、3.2±0.8,与(T0)比较有统计学差异(P<0.05)。观察组和对照组在(T1)、(T2)、(T3)各时点Ramsay指标分别为2.0±0.3、2.0±0.0、2.0±0.0和3.0±0.0、4.0±0.0、4.0±0.0,存在统计学差异(P<0.05)。两组Bromage评分、产程时间、妊娠结局、产后出血及新生儿Apgar评分无统计学意义(P>0.05)。结论 左布比卡因复合右美托咪定用于分娩镇痛安全、有效和舒适,对母婴无不良影响。

关键词: 左布比卡因;右美托咪定;舒芬太尼;分娩镇痛
Abstract:

【Abstract】Objective : To study the application of levobupivacaine combined dexmedetomidinein labor analgesia and its influence on mother and infant. Methods: In our hospital, 120 nulliparous women with term singleton fetus with cephalic presentation were randomly divided into two groups, group A with levobupivacaine combined dexmedetomidinein vs. and the control group B with levobupivacaine combined sufentanil respectively. Epidural anesthesia was used in the two groups, and epidural tube connected with electronic analgesia pump. After entering the first labor of pregnant women , we gave them epidural puncture, then two groups were given with 0.1% Levobupivacaine 5ml + 0.5 μg/ml Dexmedetomidine and 0.1% Levobupivacaine + 0.5μg/ml sufentanil 5 ml respectively. After that, it was connected with the electronic analgesia pump, set the background dose 8ml/h, PCA 5ml/time, locked in 15 min. We observed two groups of vital signs, VAS score, maternal Bromage score, Ramsay scale, labor, postpartum hemorrhage and neonatal Apgar score. Results: The blood pressure mm Hg(1 mm Hg=0.133 kPa) and heart rate of the two groups were decreased after 30min (Tb) than before anesthesia (Ta), were 10.9±0.62, 11.5±0.72 and 70±9.83, 76±8.23 respectively, then the difference between two groups is statistically significant.(P <0.05).The analgesic effect of the two groups, VAS score, at (T1), (T2) and (T3) point were different with that at point of (T0) (P <0.05), which were 1.3±0.7、3.0±0.3、3.0±0.5 and 1.7±0.6、3.5±0.7、3.2±0.8 respectively. Two groups of each point sedative effect, Ramsay index observation group was obviously lower than the control groupstatistically (P <0.05), which were 2.0±0.3、2.0±0.0、2.0±0.0和3.0±0.0、4.0±0.0、4.0±0.0. Two groups of Bromage score, lasting time, the pregnancy outcome, postpartum hemorrhage and neonatal Apgar score no (P>0.05).Conclusion: The method of levopbupivacaine combined dexmedetomidine for labor analgesia was safe, effective and comfortable, had no adverse effect on maternal and newborn.

Key words: Evobupivacaine; Dexmedetomidine; Sufentanil; labor analgesia