右美托咪定联合罗哌卡因规律性间断硬膜外注射在分娩镇痛中的临床应用

目的：观察右美托咪定联合罗哌卡因规律性间断硬膜外注射（PIEB）在分娩镇痛中的临床疗效。方法：选取2018年9月至2019年8月温州医科大学附属第一医院60例顺产足月初产妇，自愿要求实施PIEB分娩镇痛。30例芬太尼对照组（Fen组）：2 μg/mL芬太尼+0.1%罗哌卡因，30例右美托咪定组（Dex组）：0.5 μg/mL右美托咪定+0.1%罗哌卡因。2组每60 min硬膜外间隙注入8 mL上述混合药液实施分娩镇痛。记录分娩镇痛前后各时间点（分别记为T0～T6）患者心率（HR）、胎心率（FHR）和平均动脉压（MAP），比较各时间点视觉模拟评分（VAS）、拉姆齐（Ramsay）镇静评分、改良下肢运动神经阻滞（Bromage）评分，记录Apgar 5 min评分、局麻药使用总量、第一和第二产程时间、自控硬膜外镇痛（PCEA）追加及不良反应。结果：各时间点2组患者HR、FHR、MAP、改良Bromage评分、Apgar 5 min评分、第一和第二产程时间差异均无统计学意义（P＞0.05）；给药后15 min（T1）和30 min（T2）时间点，Dex组VAS评分明显小于Fen组（P＜0.05），Dex组Ramsay镇静评分明显大于Fen组（P＜0.05）；与Fen组比较，Dex组局麻药使用量及PCEA追加例数明显减少（P＜0.05）；Dex组和Fen组的不良反应差异无统计学意义（P＞0.05）。结论：产妇分娩镇痛采用右美托咪定联合罗哌卡因PIEB模式的局麻药使用量和爆发痛次数更少，镇痛和镇静效果更好。

Clinical application of dexmedetomidine combined with ropivacaine for programmed intermittent epidural bolus in labor analgesia

Objective: To discuss the clinical application effect of dexmedetomidine combined with ropivacaine for programmed intermittent epidural bolus (PIEB) in labor analgesia. Methods: Sixty primiparas admitted to the First Affiliated Hospital of Wenzhou Medical University from Sep 2018 to August 2019 were randomly divided into two groups: fentanyl group (Fen group, n=30) received epidural 2 μg/mL fentanyl and 0.1% ropivacaine, whereas the other dexmedetomidine group (Dex group, n=30) received epidural 0.5 μg/mL dexmedetomidine and 0.1% ropivacaine. Both groups were given epidural analgesic solution of 8 mL every 60 minutes respectively. The heart rate (HR), fetal heart rate (FHR), and mean arterial pressure (MAP) were assessed at the beginning of analgesia (T0), 15 min (T1), 30 min (T2), 1 h (T3), 2 h (T4) after analgesia, beginning of the second stage (T5), and 1 h after delivery (T6). Pain visual analogue scale (VAS), Ramsay sedation score, and modified Bromage score were assessed. And the neonatal Apgar score of 5 min, anesthetics consumptions, first and second stage, side effects, and PCEA attempts numbers were also observed. Results: The HR, FHR, MAP, modified Bromage score, the first and second stage, and neonatal Apgar score of 5 min did not show significant difference between 2 groups (P>0.05). Compared with Fen group, The VAS of Dex group were extremely declined and the Ramsay sedation score were significantly increased at T1 and T2 (P<0.05). The anesthetics consumptions and PCEA attempts numbers of Dex group were definitely lower than Fen group (P<0.05). The side effect did not show significant difference between 2 groups (P>0.05). Conclusion: The dexmedetomidine combined with ropivacaine for pieb in labor analgesia reduces local anesthetics consumption and pain outbreak, and has better analgesic and sedative effect.