右美托咪定辅助硬膜外神经阻滞无痛分娩临床研究.docVIP

右美托咪定辅助硬膜外神经阻滞无痛分娩临床研究 　　[摘要] 目的 探讨右美托咪定静脉注射辅助硬膜外神经阻滞无痛分娩的有效性以及安全性。方法 单胎足月产妇40例，随机分为两组。C组（n=20）：硬膜外穿刺置管注入局麻药（0.125%罗哌卡因与芬太尼1.5 μg/mL）10 mL后实施 PCEA，单次剂量4 mL，锁定时间15 min，背景剂量4 mL/h；D组（n=20）：常规硬膜外阻滞外辅助静脉注射右美托咪定0.2 μg/（kg?h）。监测ECG、RR、BP、SpO2，视觉模拟评分评估镇痛效果并观察记录产程进展、新生儿情况及不良反应。 结果 第一、二产程组间VAS评分D组优于C组（P0.05），各组新生儿各时点 Apagr评分差异无统计学意义；第二产程C组的时间延长（P0.05）；产妇的生命体征、宫缩及胎心组间无显著性差异。结论 静脉注射右美托咪定可以优化传统无痛分娩模式，减少PCEA用药量，产妇在分娩时更加舒适。 　　[关键词] 右美托咪定；硬膜外神经阻滞；无痛分娩 　　[中图分类号] R614 [文献标识码] B [文章编号] 1673-9701（2014）23-0058-04 　　[Abstract] Objective To investigate the efficacy and safety of dexmedetomidine intravenous assisted epidural anesthesia for labor analgesia. Methods Forty full term puerperant who had a single fetus were randomly divided into two groups， Group C（n=20）， a catheter was advanced into epidural space，anesthetic drugs（0.125% ropivacaine with fentanyl 1.5 μg/mL）of 10 ml was infused，then implement PCEA（bolus 4 mL with 15 min lockout interval，background infusion 4mL/h）.Group D（n=20）assisted the routine epidural block anesthesia with intravenous injection of dexmedetomidine，which was infused 0.2 μg/（kg?h）. ECG，RR，BP，SpO2，analgesic effect were assessed by VAS，labor process，mode of delivery，Apgar score of neonates and side effects of analgesia were recorded. Results The VAS during the first and second stages of labor in group D were better than group C（P0.05），there was no significant difference in Apar score between two groups. The second stage of labor in group C had an extended period of time（P0.05）. There was no significant difference in vital signs，fetal heart rate and uterine contraction between two groups. Conclusion Intravenous dexmedetomidine can optimize the traditional labor analgesia mode and reduce the dosage of PCEA.The puerperants can be more comfortable and effective in accouchement. 　　[Key words] Dexmedetomidine； Epidural anesthesia； Labor analgesia 　　产妇分娩过程是一个剧烈疼痛的生理过程[1]，无痛分娩能够有效减轻分娩疼痛，辅助产妇进行分娩。分娩镇痛方法有精神法镇痛、药物镇痛、温水浴分娩镇痛[2]以及电刺激分娩镇痛[3]、穴位配合麻醉镇痛药进行无痛分娩等，但是这些镇痛方法并不