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

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/mL vs (361.1±97.6)μIU/mL]、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) vs 3.3%(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。

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

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 signifi-cant differences between two groups in the recovery of bowel movement [(17.5±7.6) h vs (15.7±8.1) h], plasma prolac-tin level [(353.7±82.7)μIU/mL vs (361.1±97.6)μIU/mL] 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 dif-ferences between two groups in nausea [26.7%(8/30) vs 10.0%(3/30)], dizziness [26.7%(8/30) vs 33.3%(10/30)], pru-ritus [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 ef-fective analgesia without adverse effects on breast-feeding and NACS, and dexmedetomidine can effectively decrease the adverse effects of opioids drugs for intravenous analgesia.