不同剂量右美托咪定对地佐辛联合氟比洛芬酯术后剖宫产妇镇痛效应及早期康复的影响

摘要

Objective To investigate the influence of dexmedetomidine at different doses on analgesic effect and early rehabilitation in patients received Cesarean section with postoperative self -control anesthesia using dezocine com-bined with flurbiprofen.Methods A total of 120 patients(ASAⅠ-Ⅱ)received caesarean section with spinal anesthe-sia were selected and randomly assigned into 4 groups(Group DF,D1,D2 and D3).The PCIA formulation in Group DF was dezocine of 25 mg combined with flurbiprofen of 150 mg and diluted into100 mL solution.The loading dose(LD)in Group was 5 mL.The LDs in Group D1,D2 and D3 were 5 mL combined with Dex of 0.3,0.4 and 0.5 μg/kg,respec-tively.A randomized double-blind control study was conducted.The spinal anesthesia plane was at T6.The LCP mode was used:LD plus continuous infusion dose(CI)of 2 mL plus single dose(Bolus)of 2 mL for 24 hours.VAS scores for resting uterine contraction pain,VAS scores for dynamic pain and Ramsay sedation score were recorded 0 h,2 h,4 h,6 h,8 h,12 h and 24 h after operation.The maternal PCIA dosage,the pressing times of PCIA pump(P1),the actual ef-fective number(P2),the possible side effects,the postoperative aerofluxus time(H),the analgesic effect and the com-prehensive comfort were recorded.Results The total amounts of dezocine and flurbiprofen in Group D 2 and D3 were sig-nificantly less than those in Group DF and D1(P<0.05).The VAS scores of resting contraction pain and dynamic pain in Group D2 and D3 significantly lower than Group DF 4-24 h after operation(P<0.05), and significantly lower than Group D1 4-12 h after operation(P<0.05).Furthermore, the pressing times of PCIA(P1)and the actual effective number(P2)were also significantly lower than Group DF and D 1 6-24 h after operation(P<0.05).The Ramsay score in Group D3 was significantly increased 2-24 h after operation, and the incidences of hypotension and bradycardia in Group D3 were significantly higher than those in Group D 1,D2 and DF(P<0.05).The incidences of nausea,vomiting and chill were significantly lower in all Group D 1,D2 and D3 than those in Group DF(P<0.05).The moderate dose of Dex leaded to the most comfortable situation after operation.There was no significant difference in postoperative aerofluxus time among the 4 groups(P>0.05).Conclusion Dex can enhance the intravenous analgesia effect of dezocine combined with flurbiprofen after cesarean section,reduce the side effect.The suggested LD and CI doses of Dex were 0.4 μg/kg.%目的 探讨不同剂量右美托咪定(Dex)对地佐辛联合氟比洛芬酯术后剖宫产妇静脉自控镇痛(PCIA)效应及早期康复的影响.方法 选择单纯细针蛛网膜下腔阻滞(腰麻)下行剖宫产术的产妇120例, ASAⅠ~Ⅱ级,随机均分为4组(DF组、D1组、D2组和D3组),每组30例.DF组PCIA泵内药物配方为地佐辛25 mg配伍氟比洛芬酯150 mg镇痛液100 mL.4组PCIA泵内分别加入Dex 0、0.3、0.4、0.5 μg/kg加入镇痛液100 mL中,其负荷剂量(LD)为5 mL.行随机双盲对照观察.4组采用的腰麻,术中麻醉平面达T6,术后采用PCIA模式进行静脉镇痛;PCIA均采用LCP模式:LD+持续输注剂量(CI)2 mL+单次自控按压剂量(Bo-lus)2 mL,镇痛24 h.观察术后即刻、2、4、6、8、12、24 h时行静息时宫缩痛VAS评分、活动时伤口VAS评分、Ramsay镇静评分;记录各组产妇PCIA用药量,PCIA泵的按压次数(P1)和实际有效次数(P2)及可能发生的不良反应、术后排气时间、产妇对其镇痛效果和综合舒适满意度.结果 D2组和D3组PCIA泵用药总量、地佐辛和氟比洛芬酯用药量明显少于DF组和D1组(P<0.05),D2组和D3组静息宫缩痛和动态痛VAS评分在术后4~24 h明显低于DF组(P<0.05);在术后4~12 h明显低于D1组(P<0.05);且术后6~24 h各时段PCIA按压次数(P1)及实际有效次数(P2)明显少于DF组和D1组(P<0.05).D3组Ramsay评分在术后2~24 h明显升高,且低血压和心动过缓发生率明显高于D1组、D2组和DF组(P<0.05);D1组、D2组、D3组恶心、呕吐和寒战发生率明显少于DF组(P<0.05),其中使用中剂量Dex术后镇痛产妇的舒适满意度最高,排气时间差异无统计学意义(P>0.05).结论 Dex可增强剖宫产手术后产妇地佐辛联合氟比洛芬酯静脉镇痛的效应,减少不良反应,有利于提高产妇的舒适满意度,可加速产妇早期康复,其PCIA应用Dex负荷剂量及持续输注最佳推荐剂量为0.4 μg/kg.