文章摘要
不同剂量右美托咪定在剖宫产产妇术后多模式镇痛效果的比较
Comparison of different doses of dexmedetomidine in postoperative multimodal analgesia for puerpera after cesarean section
  
DOI：10.12089/jca.2022.08.006
中文关键词: 右美托咪定  术后镇痛  剖宫产术  泌乳素  多模式镇痛
英文关键词: Dexmedetomidine  Postoperative analgesia  Cesarean section  Prolactin  Multimodal analgesia
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作者单位E-mail
刘占立 518020,深圳市人民医院（暨南大学第二临床医学院,南方科技大学第一附属医院）麻醉科  
朱丽洁 518020,深圳市人民医院（暨南大学第二临床医学院,南方科技大学第一附属医院）麻醉科  
刘颖 518020,深圳市人民医院（暨南大学第二临床医学院,南方科技大学第一附属医院）麻醉科  
程静 518020,深圳市人民医院（暨南大学第二临床医学院,南方科技大学第一附属医院）麻醉科  
张中军 518020,深圳市人民医院（暨南大学第二临床医学院,南方科技大学第一附属医院）麻醉科 luckydoczhang@163.com 
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中文摘要:
      
目的 观察不同剂量右美托咪定用于剖宫产术后多模式镇痛的效果。
方法 选择腰-硬联合麻醉下行剖宫产产妇120例，年龄20～45岁，BMI 20～35 kg/m2，ASA Ⅰ或Ⅱ级，随机分为四组：D1组、D2组、D3组和C组，每组30例。胎儿剖出后，D1组、D2组和D3组产妇15 min内静脉泵注右美托咪定0.5 μg/kg，C组予等量生理盐水泵注。所有产妇术后连接自控静脉镇痛（PCIA）泵，镇痛液配方：在氟比洛芬酯4 mg/kg+托烷司琼5 mg基础上，D1组、D2组和D3组分别加入右美托咪定1、2、3 μg/kg，C组不加右美托咪定，各组再用生理盐水稀释至100 ml。记录产妇术后6、12、24、48 h VAS疼痛评分、宫缩痛评分、Ramsay镇静评分。记录PCIA有效按压次数、补救镇痛例数及不良反应的发生情况。记录术前和术后泌乳素(PRL)浓度以及术后72 h泌乳量评分。
结果 与C组比较，术后12、24、48 h D2组和D3组VAS疼痛评分和宫缩痛评分明显降低（P<0.05），D3组Ramsay镇静评分明显增高（P<0.05）。与C组比较，D1组、D2组和D3组产妇PCIA有效按压次数明显减少（P<0.05），补救镇痛率明显降低（P<0.05），D2组和D3组术后皮肤瘙痒发生率明显降低（P＜0.05），D3组术后心动过缓和低血压发生率明显升高（P＜0.05），D3组术后PRL浓度和术后72 h泌乳量评分明显升高（P<0.05）。
结论 右美托咪定2～3 μg/kg复合氟比洛芬酯用于PCIA可以改善剖宫产产妇术后镇痛的效果，促进乳汁分泌，但需警惕心动过缓和低血压的发生。
英文摘要:
      
Objective To observe the effects of different doses of dexmedetomidine in postoperative multimodal analgesia for puerpera after cesarean section.
Methods A total of 120 patients, aged 20-45 years, BMI 20-35 kg/m2, ASA physical status Ⅰ or Ⅱ, underwent cesarean section under combined spinal and epidural anesthesia were selected. They were randomly divided into four groups: group D1, group D2, group D3 and group C, 30 patients in each group. Groups D1, D2 and D3 were given intravenous infusion of 0.5 μg/kg dexmedetomidine in 15 minutes after neonatal removal, and group C was given normal saline infusion of the same amount. Patient-controlled intravenous analgesia (PCIA) were conducted in the four groups after surgery. Analgesic formula: on the basis of fluransetron axetil 4 mg/kg + tolansetron 5 mg, groups D1, D2 and D3 were given dexmedetomidine 1, 2 and 3 μg/kg respectively, and group C was not given dexmedetomidine, and all groups were mixed with normal saline to 100 ml respectively. VAS score, contractions pain score, and Ramsay sedation score 6, 12, 24, and 48 hours after surgery were recorded. Effective pressing times of PCIA, additional analgesia, adverse reactions, preoperative and postoperative prolactin (PRL) values and postoperative lactation score 72 hours after surgery were recorded.
Results Compared with group C, the VAS score and the contractions pain score in groups D2 and D3 were significantly decreased (P < 0.05), and Ramsay sedation score in group D3 was significantly increased 12, 24, and 48 hours after surgery (P < 0.05). Compared with group C, the effective pressing times of PCIA and the analgesic rates in groups D1, D2 and D3 were significantly decreased (P < 0.05); the pruritus incidence in groups D2 and D3 were decreased significantly (P < 0.05); the incidence of postoperative bradycardia and hypotension in group D3 were significantly increased (P < 0.05); the postoperative PRL values and postoperative lactation score 72 hours after surgery in group D3 were increased significantly (P < 0.05).
Conclusion Dexmedetomidine 2-3 μg/kg combined with flurbiprofen ester for PCIA can improve the analgesic effect after cesarean section and promote lactation.
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