2018 年第 7 期 第 13 卷

右美托咪定联合舒芬太尼对产妇剖宫产术后的镇痛效果

Analgesic effect of dexmedetomidine combined with sufentanil on patients with cesarean section

作者：王玉嘉葛春林

英文作者：

单位：200443上海市静安区市北医院重症医学科（王玉嘉）；200030上海市徐汇区中心医院麻醉科（葛春林）

英文单位：

关键词：剖宫产术；右美托咪定；舒芬太尼；镇痛

英文关键词：

• 摘要：

• 【摘要】目的    评价右美托咪定联合舒芬太尼对产妇剖宫产术后的镇痛效果。方法    选择2016年1月24日至9月24日就诊于上海市同仁医院的产妇120例，均在硬膜外麻醉下行剖宫产手术。按照随机数字表法分为A、B、C 3组，每组40例。A组产妇分娩后静脉注射20 ml 0.9%氯化钠注射液，患者自控镇痛（PCA）方案为舒芬太尼以 0.015 μg/（kg·h）的连续剂量和0.023 μg/kg的静脉推注剂量施用，锁定时间为8 min；B组产妇分娩后静脉注射（浓度稀释至4 μg/ml)0.5 μg/kg的右美托咪定，PCA方案同A组；C组产妇分娩后静脉注射0.5 μg/kg的右美托咪定，PCA方案为舒芬太尼0.015 μg/（kg·h）联合右美托咪定0.045 μg/(kg·h)，锁定时间为8 min。比较3组术后4、8、24 h舒芬太尼使用量和疼痛视觉模拟量表（VAS）评分，麻醉前和麻醉后1 h产妇疼痛阈值和疼痛耐受阈值（PTTh），以及临床治疗满意度。结果    C组产妇术后24 h内舒芬太尼消耗量低于A组和B组［（44±19）μg比（54±24）、（56±21）μg］，差异有统计学意义（P＜0.05）。剖宫产术后4、8、24 h，C组产妇VAS评分明显低于A组和B组［（2.60±0.20）分比（3.80±0.32）、（3.60±0.17）分，（2.10±0.27）分比（3.40±0.15）、（3.50±0.16）分，（1.70±0.31）分比（2.60±0.23）、（2.60±0.29）分］，差异均有统计学意义（均P＜0.05）。硬膜外给予布比卡因后1 h，B组和C组产妇疼痛阈值、PTTh明显高于A组［（1.6±0.4）、（1.7±0.4）mA比（1.5±0.5）mA，（2.6±0.5）、（2.6±0.5）mA比（2.4±0.6）mA］，差异均有统计学意义(均P＜0.05)。C组“非常满意”比例高于A组和B组，“满意”和“一般”比例低于A组和B组，差异均有统计学意义（均P＜0.05）。结论    相比单药方案，联合使用舒芬太尼和右美托咪定用于剖宫产术后镇痛，可以减少舒芬太尼使用量，增强止痛效果，提高疼痛阈值，提高产妇对临床治疗的满意度。

• 【Abstract】Objective    To evaluate the analgesic effect of dexmedetomidine combined with sufentanil on patients with cesarean section. Methods    A total of 120 patients undergoing cesarean section under epidural anesthesia in Shanghai Tongren Hospital from 24th, January to 24th September in 2016 were randomly divided into group A, B and C, with 40 cases in each group. Group A had intravenous injection of 20 ml 0.9% sodium chloride solution after operation; sulfentanyl was used for postoperative patient-controlled analgesia（PCA） with 0.015 μg/（kg·h） for continuous infusion and 0.023 μg/kg for intravenous injection, 8 min. Group B had intravenous injection of 0.5 μg/kg dexmedetomidine after operation and the same PCA scheme as group A. Group C had intravenous injection of 0.5 μg/kg dexmedetomidine after operation; PCA scheme was sulfentanyl 0.015 μg/（kg·h） combined with dexmedetomidine 0.045 μg/(kg·h) for continuous infusion, 8 min. Consumption of sufentanil and score of the Visual Analogue Scale(VAS) for pain were measured at 4, 8, 24 h after operation. Maternal pain threshold(PTh) and pain tolerance threshold(PTTh) were measured before and 1 h after anesthesia. Clinical treatment satisfaction was measured before discharge. Results    Sufentanil dosage in 24 h after operation in group C was significantly lower than that in group A and B［（44±19）μg vs （54±24）,（56±21）μg］（P＜0.05）. At 4, 8, 24 h after operation, VAS scores in group C were significantly lower than those in group A and B［（2.60±0.20） vs （3.80±0.32）,（3.60±0.17）; （2.10±0.27） vs （3.40±0.15）,（3.50±0.16）;（1.70±0.31） vs （2.60±0.23）,（2.60±0.29）］(P<0.05). At 1 h after epidural administration of bupivacaine, PTh and PTTh in group B and C were significantly higher than those in group A［（1.6±0.4）,（1.7±0.4）mA vs （1.5±0.5）; （2.6±0.5）,（2.6±0.5）mA vs （2.4±0.6）mA］(P＜0.05). Satisfaction ratio in group C was significantly higher than that in group A and B(P<0.05). Conclusion    Combined use of sufentanil and dexmedetomidine for postoperative analgesia in patients with cesarean section can reduce sufentanil dose, increase PTh, enhance the analgesic effect and improve patient satisfaction.

  【Key words】Cesarean section;Dexmedetomidine;Sufentanil;Analgesia