2020 年第 11 期 第 15 卷

不同浓度罗哌卡因复合右美托咪定对妊娠高血压综合征产妇分娩镇痛效果的随机对照研究

Effect of dexmedetomidine combined with ropivacaine of different concentrations on labor analgesia in patients with pregnancy-induced hypertension syndrome

作者：李颖1黄海清2池萍3邵刘佳子1

英文作者：Li Ying1 Huang Haiqing2 Chi Ping3 Shao Liujiazi1

单位：1首都医科大学附属北京友谊医院麻醉科100050；2广西医科大学第二附属医院麻醉科，南宁530007；3首都医科大学附属北京佑安医院麻醉科100069

英文单位：1Department of Anesthesiology Beijing Friendship Hospital Capital Medical University Beijing 100050 China; 2Department of Anesthesiology the Second Affiliated Hospital of Guangxi Medical University Nanning 530007 China; 3Department of Anesthesiology Beijing You′an Hospital Capital Medical University Beijing 100069 China

关键词：妊娠高血压综合征；分娩镇痛；右美托咪定；罗哌卡因 

英文关键词：Pregnancy-inducedhypertension；Laboranalgesia；Dexmedetomidine；Ropivacaine

• 摘要：

• 目的 探讨不同浓度罗哌卡因复合右美托咪定对妊娠高血压综合征（妊高征）产妇分娩镇痛的效果。方法 选择2018年5月至2019年5月首都医科大学附属北京友谊医院收治的180例妊高征患者，按照随机数字表法分为3组，各60例。0.05%、0.075%、0.1%浓度组患者分别经硬膜外导管注入0.05%、0.075%、0.1%罗哌卡因复合0.5 mg/L右美托咪定混合液10 ml。比较3组产妇不同时点的疼痛视觉模拟量表评分及体温，T0为分娩镇痛即刻、T1～T6分别为镇痛后1～6 h。比较3组产妇硬膜外阻滞安全性、镇痛时间、产程时间、镇痛药物使用情况（罗哌卡因、右美托咪定用量及硬膜外自控镇痛按压次数）、催产素使用比例、分娩方式（自然分娩、应用产钳、中转剖宫产）和产妇满意度。结果 治疗后，3组产妇T1～T6时点的疼痛视觉模拟量表评分均低于T0时点，T4～T6时点体温均高于T0时点，且0.05%浓度组、0.075%浓度组T4、T5时点体温低于0.1%浓度组，差异均有统计学意义（均P＜0.05）。0.05%浓度组、0.075%浓度组产间发热比例均低于0.1%浓度组［6.7%(4/60)、8.3%（5/60）比23.3%（14/60）］，差异均有统计学意义（均P＜0.05）。3组产妇的改良Bromage评分＞1分、单侧阻滞、1 min新生儿Apgar评分＞8分和5 min新生儿Apgar评分＞8分比例、胎心率、出血量、新生儿体质量比较，差异均无统计学意义（均P＞0.05）。0.05%浓度组、0.075%浓度组产妇硬膜外自控镇痛按压次数均多于0.1%浓度组［（1.9±0.7）、（1.6±0.9）次比（1.3±0.5）次］，0.05%浓度组产妇右美托咪定用量多于0.075%浓度组和0.1%浓度组［（46±7）mg比（36±6）、（36±7）mg］，差异均有统计学意义（均P＜0.05）。3组产妇镇痛时间、产程时间、罗哌卡因用量比较，差异均无统计学意义（均P＞0.05）。0.075%浓度组产妇治疗满意度显著高于0.05%浓度组和0.1%浓度组（均P＜0.05）；3组产妇催产素使用比例、分娩方式比较，差异均无统计学意义（均P＞0.05）。结论 妊高征产妇应用0.075%罗哌卡因复合右美托咪定行分娩镇痛，可有效改善分娩疼痛感，安全性及产妇满意度均较高。

• Objective To investigate the effect of dexmedetomidine combined with ropivacaine of different concentrations on parturition analgesia in patients with pregnancy-induced hypertension syndrome(PIH). Methods Totally 180 patients with PIH admitted to Beijing Friendship Hospital, Capital Medical University from May 2018 to May 2019 were randomly divided into three groups, with 60 in each group. Patients in the 0.05%, 0.075% and 0.1% concentration groups were injected with 0.05%, 0.075%, 0.1% ropivacaine and 0.5 mg/L dexmedetomidine mixture 10 ml through epidural catheter respectively. The scores of Visual Analogue Scale (VAS) and body temperature at different time points were compared. T0 was the instant of labor analgesia and T1-T6 was 1-6 h after analgesia. The safety of epidural block, the time of analgesia, the time of labor, the use of analgesic drugs (the dosage of ropivacaine and dexmedetomidine, the times of patient controlled epidural analgesia pressing), the proportion of oxytocin use, the mode of delivery (natural delivery, forceps application, conversion to cesarean section) and maternal satisfaction were analyzed. ResultAfter treatment, the VAS scores of the three groups at the T1-T6 were lower than those at the T0; the body temperatures at the T4-T6 were higher than that at the T0; the body temperatures of the 0.05% concentration group and the 0.075% concentration group at the T4 and T5 were lower than that in 0.1% concentration group; the differences were statistically significant (all P＜0.05). The fever rates of 0.05% concentration group and 0.075% concentration group during delivery were lower than that of 0.1% concentration group ［6.7%(4/60), 8.3%(5/60) vs 23.3%(14/60)］(both P＜0.05). There were no significant differences of the proportion of Modified Bromage score＞1 score, unilateral block, newborn Apgar score＞8 in one minute, newborn Apgar score＞8 in five minutes, fetal heart rate, blood lossand body mass of newborn among the three groups (all P＞0.05). The frequencies of epidural analgesia compression in the 0.05% concentration group and 0.075% concentration group were more than that in the 0.1% concentration group ［(1.9±0.7), (1.6±0.9)times vs (1.3±0.5)times］; the dexmedetomidine dosage in the 0.05% concentration group was more than that in the 0.075% concentration group and 0.1% concentration group ［（46±7）mg vs （36±6）,（36±7）mg］(both P＜0.05). There were no significant differences in analgesia time, labor time and ropivacaine dosage among the three groups (all P＞0.05). The treatment satisfaction of 0.075% concentration group was significantly higher than that of 0.05% concentration group and 0.1% concentration group (both P＜0.05); there were no significant differences among the three groups in the ratio of oxytocin use and delivery mode (both P＞0.05). ConclusionThe use of 0.075% ropivacaine combined with dexmedetomidine for labor analgesia in patients with pregnancy-induced hypertensioncan effectively improve the labor pain, safety and maternal satisfaction.