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| 右美托咪定复合布托啡诺在剖宫产术后镇痛的应用 |
| Effects and safety of intravenous dexmedetomidine combined with butorphanol for post caesarean section analgesia |
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| DOI：10.12089/jca.2018.09.002 |
| 中文关键词: 右美托咪定 哺乳 剖宫产术 镇痛 |
| 英文关键词: Dexmedetomidine Breastfeeding Caesarean section Analgesia |
| 基金项目: |
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| 中文摘要: |
目的 研究右美托咪定复合布托啡诺用于剖宫产术产妇自控静脉镇痛(PCIA)的安全性和临床效果。
方法 选择择期硬膜外麻醉下行剖宫产术产妇60例, 年龄24～43岁, 身高153～171 cm, 体重53～93 kg, ASA Ⅰ或Ⅱ级，采用随机数字表法将产妇分为两组(n = 30)。对照组(C组)：胎儿娩出断脐后静脉给予生理盐水30 ml, 术后PCIA(布托啡诺3 μg·kg-1·h-1, 背景输注速率2 ml/h,每次按压0.5 ml, 锁定时间10 min);右美托咪定组(D组)：胎儿娩出断脐后静脉给予右美托咪定0.5 μg/kg, 术后PCIA(布托啡诺3 μg·kg-1·h-1复合右美托咪定0.05 μg·kg-1·h-1, 背景输注速率2 ml/h,每次按压0.5 ml, 锁定时间10 min)。记录术后6、12、24和48 h安静、运动和宫缩状态下的VAS评分;术后48 h内产妇泌乳后取乳汁, 采用高效液相色谱质谱联用法(HPLC-MS/MS)测定乳汁中右美托咪定浓度并计算相对婴儿摄取量(RID)；记录术后产妇满意度以及不良反应的发生情况。
结果 与C组比较, D组在术后6、12、24 h安静、运动和宫缩状态下VAS评分明显降低(P<0.05)，D组在术后48 h运动VAS评分明显降低(P<0.05);D组产妇满意度明显高于C组(P<0.05)；D组右美托咪定RID值为(0.197±0.114)％；两组术后均未发生低血压、低氧血症、呼吸抑制、心动过缓以及恶心和呕吐等不良反应。
结论 健康产妇围术期使用右美托咪定可安全哺乳。术后镇痛使用布托啡诺复合0.05 μg·kg-1·h-1右美托咪定能够提供满意的镇痛效果。 |
| 英文摘要: |
Ojective To observe the effects and safety of intravenous dexmedetomidine combined with butorphanol for post caesarean section analgesia.
Methods Sixty parturients undergoing scheduled caesarean section aged 24 - 43 years, heighing 153 - 171 cm, weighing 53 - 93 kg, ASA physical status Ⅰ or Ⅱ, were enrolled and received 0.5 μg/kg dexmedetomidine or 0.9％ sodium chloride after delivery and cord clamping, followed by butorphanol 3 μg·kg-1·h-1 only (group C) or combined with dexmedetomidine at 0.05 μg·kg-1·h-1 (group D) for postoperative analgesia. The VAS at 6, 12, 24 and 48 h after caesarean section when patients at rest, movement and uterine cramping were record. Also a questionnaire survey of analgesia satisfaction was completed at 48 h after surgery. Dexmedetomidine concentration in the breast milk was detected by HPLC-MS/MS for the calculation of the relative infant dose (RID).
Results At 6, 12 and 24 h after operations, VAS in group D at rest, movement and uterine cramping, were significantly lower than that in group C (P < 0.05). At 48 h after operations, VAS in group D at movement was significantly lower than that in group C (P < 0.05). The patients in group D showed higher degree of analgesia satisfaction than group C (P < 0.05). Breast milk samples were collected from 15 patients. The RID of dexmedetomidine was (0.197 ± 0.114)％ in group D.
Conclusion Intravenous infusion of dexmedetomidine at 0.05 μg·kg-1·h-1 is safe in healthy parturients for baby breastfeeding when combined with butorphanol in PCIA for satisfactory analgesia. |
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