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

目的 研究左布比卡因复合右美托咪定(dexmedetomidine,Dex)在分娩镇痛中的应用及对母儿的影响. 方法 120例单胎、头位、初产妇,采用随机数字表法分为两组(每组60例),观察组(A组)应用左布比卡因复合Dex,对照组(B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.产妇行硬膜外穿刺,两组分别给予0.1％左布比卡因+0.5 mg/L Dex复合液和0.1％左布比卡因+0.5 mg/L舒芬太尼复合液各5 ml.连接泵镇痛,泵速设置为8ml/h,患者自控镇痛(patient controlled analgesia,PCA)追加5 ml/次,锁定15 min.观察两组产妇生命体征、VAS评分、Bromage评分、Ramsay评分、产程、产后出血及新生儿Apgar评分. 结果 与麻醉前(T0)比较,麻醉后30 min(Tt)两组产妇MAPA组,(81.8±4.7) mmHg(1 mmHg=0.133 kPa)比(93.0±6.2) mmHg;B组,(86.3±5.4)mmHg比(93.8±7.0) mmHg]、HRA组,(70±10)次/min比(90±10)次/min;B组,(76±8)次/min比(88±8)次/min]均降低(P＜0.05).VAS评分,在T0、T1、活跃期1 h(T2)、第二产程1 h(T3)时,A组分别为(8.6±1.1)、(1.3±0.7)、(1.7±0.6)、(3.5±0.7)分,B组分别为(8.8±1.2)、(3.0±0.3)、(3.0±0.5)、(3.2±0.8)分,两组差异有统计学意义(P＜0.05).Ramsay评分在T1～T3时点,B组(3.0±0.2)、(4.0±0.3)、(4.0±0.1)分]与A组(2.0±0.3)、(2.0±0.2)、(2.0±0.1)分]比较,差异有统计学意义(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评分比较,差异无统计学意义(P＞0.05). 结论 左布比卡因复合Dex用于分娩镇痛安全、有效、舒适.

Application of levobupivacaine combined with dexmedetomidine in labor analgesia and its influence on mother and infant

Objective To study the application of levobupivacaine combined dexmedetomidine (Dex) in labor analgesia and its influence on mother and infant.Methods One hundred and twenty nulliparous women with term singleton fetus with cephalic presentation in our hospital were randomly divided into two groups (n=60),the observation group (group A) with levobupivacaine combined Dex and the control group(group B) with levobupivacaine combined sufentanil.Epidural analgesia was performed in the two groups with electronic analgesia pump.After entering the first labor,epidural puncture was done and then two groups were given with 0.1％ levobupivacaine+0.5 mg/L Dex (5 ml) and 0.1％ levobupivacaine+0.5 mg/L sufentanil (5 ml),respectively.After that,the electronic analgesia pump was connected,the background dose was set at 8 ml/h and patient controlled analgesia dose was 5 ml/time with a lock time of 15 min.The vital signs,VAS score,Bromage score,Ramsay scale,labor,postpartum hemorrhage and neonatal Apgar score were observed in the two groups.Results Compared with the baselines before anesthesia (T0),the MAP group A:(81.8±4.7) mmHg(1 mmHg=0.133 kPa) vs (93.0±6.2) mmHg,group B:(86.3±5.4) mmHg vs (93.8±7.0) mmHg] and HRgroup A:(70±10) bpm vs (90±10) bpm,group B:(76±8) bpm vs (88±8) bpm] after 30 min(T1) in the two groups decreased (P＜0.05).The VAS scores at T0,T1,T2(the active period of labor 1 h),T3(the second stage of labor 1 h) observed points were (8.6±1.1),(1.3±0.7),(1.7±0.6) and (3.5±0.7) in group A,respectively,and (8.8±1.2),(3.0±0.3),(3.0±0.5) and (3.2±0.8) in group B,with statistical differences between two groups (P＜0.05).The Ramsay scores at T1,T2 and T3 observed points were (2.0±0.3),(2.0±0.2),(2.0±0.1) in group A,respectively,and (3.0±0.2),(4.0±0.3) and (4.0±0.1) in group B,with statistical differences between two groups (P＜0.05).The two groups were comparable with respective to the Bromage score,lasting time,the pregnancy outcome,postpartum hemorrhage and neonatal Apgar score (P＞0.05).Conclusions The use of levopbupivacaine combined Dex for labor analgesia is safe,effective and comfortable,had almost no adverse effect on maternal and newborn.