右美托咪定复合瑞芬太尼PCIA用于分娩镇痛的临床观察

目的探讨静脉输注右美托咪定复合瑞芬太尼静脉自控镇痛用于分娩镇痛的临床效果及安全性。方法选取霸州市妇幼保健院2015年1月至2018年3月行阴道分娩、要求分娩镇痛的初产妇180例,随机分为对照组和研究组,各90例。对照组实施瑞芬太尼PCIA分娩镇痛,研究组给予瑞芬太尼PCIA+右美托咪定静脉输注分娩镇痛。比较两组产妇镇痛前、镇痛后10min、镇痛后60min、宫口开全时的疼痛视觉模拟评分(VAS)、Ramsay镇静评分、心率(HR)、平均动脉压(MAP)。记录两组产妇产程时间、胎心率以及恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应;观察比较两组新生儿Apgar评分,新生儿行为神经评分(NBNA)以及脐动脉血血气指标。结果①研究组镇痛后60min、宫口开全时VAS疼痛评分和MAP低于对照组,镇痛后10min、宫口开全时Ramsay镇静评分高于对照组,差异均具有统计学意义(P<0.05)。②与分娩镇痛前比较,两组产妇分娩镇痛60min后,AD及NA血浆浓度均有下降,但研究组下降幅度大于对照组,差异均具有统计学意义(均P<0.05)。③两组产程时间及胎心率比较,差异无统计学意义(P>0.05)。④分娩过程中对照组发生恶心呕吐23例(25.6%)、皮肤瘙痒26例(28.9%);研究组发生恶心呕吐5例(5.6%)、皮肤瘙痒7例(7.5%),对照组恶心呕吐、皮肤瘙痒的发生率明显高于研究组,差异具有统计学意义(P<0.05)。两组均未发生呼吸抑制等严重不良反应。⑤两组均未发生新生儿呼吸窘迫情况,新生儿娩出后Apgar评分、NBNA评分以及脐血pH值、PaO2、PaCO2、HCO3-等血气指标比较,差异均无统计学意义(P>0.05)。结论静脉输注右美托咪定复合瑞芬太尼静脉自控镇痛用于分娩镇痛的效果好于瑞芬太尼单用,不良反应较少。

Effects of intravenous dexmedetomidine combined with remifentanil patient-controlled intravenous analgesia on labor analgesia

Objective To investigate the effects of intravenous dexmedetomidine combined with remifentanil patient-controlled intravenous analgesia(PCIA) on labor analgesia. Methods 180 primiparas requesting epidural labor analgesia in Bazhou Maternal and Child Health Care Center from January 2015 to March 2018 were selected and divided randomly into the control group(with remifentanil PICA, n=90) and the research group(with intravenous dexmedetomidine combined with remifentanil PICA, n=90). Visual analogue scale(VAS), Ramsay score, heart rate(HR), mean arterial pressure(MAP) before analgesia, 10 min after analgesia, 60 min after analgesia, and at the time of uterine mouth opening were compared between the two groups. Labor time, fetal heart rate, the incidence of adverse reactions such as nausea and vomiting, itchy skin, respiratory depression was recorded in the two groups. Apgar scores of neonates, neonatal behavior neurological assessment(NBNA), umbilical arterial blood gas indexes were observed and compared in the two groups. Results ①VAS scores and MAP at 60 min after analgesia, and at the time of uterine mouth opening in the research group were lower than those in the control group, and Ramsay scores at 10 min after analgesia, uterine mouth opening in the research group were higher than those in the control group, all with statistically significant differences(P<0.05). ②AD and NA plasma concentrations decreased after 60 min of labor analgesia compared with these before labor analgesia in both groups, with statistically significant differences(P<0.05), but the decrease was more significant in the research group than that in the control group, with statistically significant differences(P<0.05). ③There were no statistically significant differences in labor time and fetal heart rate between the two groups(P >0.05). ④ There were 23 cases of nausea and vomiting(25.6%) and 26 cases of itchy skin(28.9%) in the control group and 5 cases of nausea and vomiting(5.6%) and 7 cases of itchy skin(7.5%) in the research group occurred during labor, with statistically significant differences between the two groups(P<0.05). No severe adverse reactions such as respiratory depression were observed. ⑤ Neonatal respiratory distress did not occurred in both groups. There was no significant difference in neonatal Apgar scores and NBNA scores after childbirth, the blood gas indexes such as pH, PaO2, PaCO2, HCO3- in umbilical cord blood between the two groups(P>0.05). Conclusions The efficacy and safety of intravenous dexmedetomidine combined with remifentanil PCIA in labor analgesia are better than remifentanil alone, with fewer adverse reactions.