右美托咪定对罗哌卡因硬膜外分娩镇痛半数效应浓度的影响

罗一; 曾思思; 高露月; 汪芳俊

doi:10.7619/jcmp.20210486

右美托咪定对罗哌卡因硬膜外分娩镇痛半数效应浓度的影响

Effect of dexmedetomidine on half maximal effective concentration of epidural analgesia by ropivacaine for labor

摘要

摘要:
目的观察右美托咪定对罗哌卡因硬膜外阻滞分娩镇痛半数效应浓度（EC₅₀）的影响。
方法选取90例自愿进行分娩镇痛的足月孕妇作为研究对象，采用随机数字表法分为对照组（罗哌卡因组）和联合组（右美托咪定联合罗哌卡因组），每组45例。2组均选择L_2~3行硬膜外穿刺置管，连接脉冲镇痛泵。对照组硬膜外脉冲镇痛泵配方为盐酸罗哌卡因和生理盐水的混合液共150 mL，联合组为盐酸罗哌卡因、右美托咪定75 μg和生理盐水的混合液共150 mL。采用Dixon-Massey法确定盐酸罗哌卡因硬膜外分娩镇痛EC₅₀及其95%置信区间（CI）。比较2组孕妇首次硬膜外腔给药前（T₀）和注药后15 min（T₁）、30 min（T₂）、1 h（T₃）、2 h（T₄）、4 h（T₅）及胎盘娩出时（T₆）7个时点的血压、心率、血氧饱和度（SpO₂）、视觉模拟评分法（VAS）评分及体温，并比较2组首次硬膜外腔注药后冷感觉阻滞平面、药物起效时间、宫口开全时间、第二产程时间、催产素使用情况以及不良事件发生情况。
结果对照组罗哌卡因分娩镇痛EC₅₀为0.078%（95% CI为0.074%~0.082%），联合组罗哌卡因分娩镇痛EC₅₀为0.062%（95% CI为0.057%~0.068%）；2组产妇硬膜外冷感觉阻滞平面均为T₈~T₉，联合组药物起效时间短于对照组，差异有统计学意义（P < 0.05）；2组T₁~T₆时点的VAS评分均低于T₀时点，差异有统计学意义（P < 0.05），2组间不同时点的VAS评分比较，差异无统计学意义（P>0.05）。T₃~T₅时点，联合组体温、心率均低于对照组，差异有统计学意义（P < 0.05）。对照组寒颤发生率高于联合组，差异有统计学意义（P < 0.05）。
结论右美托咪定可降低罗哌卡因硬膜外分娩镇痛的EC₅₀，减少孕妇寒颤和产时发热的发生。

Abstract:
Objective To observe effect of dexmedetomidine on half maximal effective concentration(EC₅₀) of epidural analgesia by ropivacaine for labor.
Methods A total of 90 full-term pregnant women with labor analgesia were selected as study objects, and were randomly divided into control group (ropivacaine group) and combined group (dexmedetomidine combined with ropivacaine group), with 45 cases in each group. Epidural pulse analgesia pumps were connected with catheters through epidural puncture (L_2~3). In the control group, the fluid in epidural pulse analgesia pump was formulated as a mixture of ropivacaine hydrochloride and normal saline for 150 mL, while the fluid of epidural pulse analgesia pump in the combined group was formulated as a mixture of ropivacaine hydrochloride, dexmedetomidine for 75 μg and normal saline for 150 mL in total. Blood pressure, heart rate, blood oxygen saturation (SpO₂), Visual Analogue Scale (VAS) scores and body temperature of pregnant women of two groups before administration in epidural space for the first time (T₀) and 15 min after drug injection (T₁), 30 min (T₂), 1 h (T₃), 2 h (T₄), 4 h (T₅) and delivery of the placenta (T₆) were compared. Cold sensation of block plane after first administration of epidural space, drug response time, cervix opening time, the second labor time, use of oxytocin, and adverse events were compared.
Results The EC₅₀ of labor analgesia by ropivacaine in the control group was 0.078%(95%CI, 0.074% to 0.082%), and was 0.062% in the combined group(95%CI, 0.057% to 0.068%). The level of epidural cold sensory block was from T₈ to T₉ in both groups. The onset time of the combined group was significantly shorter than that in the control group (P < 0.05). The VAS scores from time points of T₁ to T₆ in both groups were significantly lower than that at T₀ (P < 0.05). There were no differences in VAS scores at different time points between the two groups (P>0.05). At time points from T₃ to T₅, body temperature and hear rate in the combined group were significantly lower than those of control group (P < 0.05). The incidence of shivering in the control group was significantly higher than that in the combined group (P < 0.05).
Conclusion Dexmedetomidine can significantly reduce EC₅₀ of epidural analgesia by ropivacaine for labor, and correspondingly reduce the incidence of shivering and intrapartum fever in pregnant women.

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