罗哌卡因复合右美托咪啶硬膜外注射用于分娩镇痛的观察

目的 观察罗哌卡因复合右美托咪啶硬膜外注射用于分娩镇痛的有效性和安全性。方法 随机将120例产妇均分为右美托咪啶组和芬太尼组。硬膜外穿刺成功后，2组均注入镇痛液10 mL（0.1%盐酸罗哌卡因，右美托咪啶组和芬太尼组分别内含1 μg·mL^-1右美托咪啶和2 μg·mL^-1芬太尼）。感觉阻滞平面达T₁₀后，2组均采用上述镇痛液开始病人自控硬膜外镇痛。观察镇痛前（T₀）、镇痛后15 min（T₁）、60 min（T₂）、宫口开全时（T₃）及镇痛停止时（T₄）的Ramsay评分（RSS）、疼痛视觉模拟评分（VAS）及平均动脉压（MAP）、心率（HR）和脉搏氧饱和度（SPO₂）；观察T₀及T₂时的血浆肾上腺素和去甲肾上腺素浓度；观察第一及第二产程时间、分娩时产钳助产率、新生儿娩出后1 min Apgar评分；观察镇痛期间血压过低、心动过缓、呼吸抑制、恶心呕吐、皮肤瘙痒、过度镇静、运动阻滞、胎心异常及新生儿Apgar评分降低等不良反应的发生情况。结果 右美托咪啶组RSS、VAS评分及SPO₂与芬太尼组比较各时点均无差异。与芬太尼组比，右美托咪啶组爆发痛发生率低（P<0.05），首发时间晚（P<0.05），首发时宫口扩张大（P<0.05），MAP T₄、HR T₃及T₄降低（P<0.05），肾上腺素和去甲肾上腺素浓度T₂降低（P<0.05），恶心呕吐、皮肤瘙痒、过度镇静发生率低（P<0.05）。2组分娩情况及新生儿Apgar评分无明显差异。结论 罗哌卡因复合右美托咪啶硬膜外注射用于分娩镇痛，抑制爆发痛效果较好，恶心呕吐、皮肤瘙痒及过度镇静发生率较低。

Observation on Epidural Injection of Ropivacaine Combined with Dexmedetomidine in Labor Analgesia

OBJECTIVE To observe the effectivity and safety of epidural ropivacaine combined with dexmedetomidine in labor analgesia. METHODS One hundred and twenty nulliparous women were randomly divided into dexmedetomidine group and fentanyl group. After successful epidural puncture, maternals in dexmedetomidine group received epidural 0.1% ropivacaine 10 mL with dexmedetomidine 1 μg·mL^-1 in addition for labor analgesia, whereas maternals in fentanyl group received epidural 0.1% ropivacaine 10 mL with fentanyl 2 μg·mL^-1 in addition. The Ramsay scores(RSS) and visual analogue scale(VAS) scores, the mean arterial pressur(MAP), heart rate(HR) and pulse oxygen saturation(SPO₂) were recorded before labor analgesia(T₀), at 15 min after labor analgesia(T₁), at 60 min after labor analgesia(T₂), at the moment of complete cervical dilatation(T₃) and at the end of PCEA(T₄). Plasma epinephrine and norepinephrine concentrations in T₀ and T₂ were observed. Time of first and second stage of labor, forceps delivery rate, Apgar score 1 min after delivery were observed. The adverse reaction incidence of convulsion, hypotension, bradycardia, respiratory depression, nausea and vomiting, pruritus cutanea, excessive sedation, motor nerve block, fetal heart abnormality and eonatal Apgar score decreased were recorded too. RESULTS There were no statistically significant difference in RSS, VAS scores and SPO₂ in dexmedetomidine group and fentanyl group. Compared with the fentanyl group, the incidence of breakthrough pain were lower in dexmedetomidine group(P<0.05), and started late(P<0.05), had larger dilatation of uterine orifice at the beginning(P<0.05), the MAP at T₄ were significant lower(P<0.05). The HR at T₃ and T₄ were significant lower in dexmedetomidine group(P<0.05), the plasma catecholamine value at T₂ were significant lower(P<0.05), the incidence of nausea and vomiting, pruritus cutanea and excessive sedation were lower(P<0.05). There was no significant difference in the delivery status and neonatal Apgar scores between the two groups. CONCLUSION In labor analgesia, epidural ropivacaine combined with dexmedetomidine is more effective to treat breakthrough pain and the incidence of nausea and vomiting, pruritus cutanea and excessive sedation is lower.