天津医药

天津医药 ›› 2021, Vol. 49 ›› Issue (7): 742-747.doi: 10.11958/20210237

• 临床研究 • 上一篇    下一篇

右美托咪定滴鼻预防硬膜外分娩镇痛爆发痛的效果观察

计天珍，李锐，朱海娟，刘红霞，张野   

  1. 1安徽医科大学第二附属医院麻醉与围术期医学科（邮编230601）；2安徽省妇幼保健院麻醉科
  • 收稿日期:2021-01-27 修回日期:2021-03-16 出版日期:2021-07-15 发布日期:2021-07-12
  • 作者简介:计天珍（1987），女，硕士在读，主治医师，主要从事产科分娩镇痛、产科危重症麻醉方面研究。E-mail：happy_tianzhen@126.com
  • 基金资助:
    合肥市卫生计生委2017年应用医学研究项目（hwk2017zd003）

Effects of intranasal dexmedetomidine on preventing breakthrough pain of epidural labor analgesia

JI Tian-zhen, LI Rui, ZHU Hai-juan, LIU Hong-xia, ZHANG Ye   

  1. 1 Department of Anesthesiology and Perioperative Medicine, the Second Hospital of Anhui Medical University, Hefei 230601, China; 2 Department of Anesthesiology, Anhui Province Maternity ＆ Child Health Hospital
  • Received:2021-01-27 Revised:2021-03-16 Published:2021-07-15 Online:2021-07-12

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摘要： 目的　探讨右美托咪定滴鼻预防硬膜外分娩镇痛爆发痛的效果。方法　选择单胎足月初产妇100例，美国麻醉医师协会（ASA）Ⅰ或Ⅱ级，随机分为对照组和右美托咪定滴鼻组（观察组）。观察组在硬膜外镇痛后20 min给予0.8 µg/kg右美托咪定滴鼻，对照组给予等量生理盐水滴鼻。记录各组爆发痛发生率、首次爆发痛发生时间、患者自控硬膜外镇痛（PCEA）按压次数、镇痛药总量、产妇满意度和产程时间，评价右美托咪定滴鼻对硬膜外分娩镇痛爆发痛的预防效果。记录硬膜外镇痛前（T0）、镇痛后1 h（T1）、2 h（T2）、3 h（T3）、4 h（T4）、宫口开全时（T5）、胎儿娩出时（T6）产妇的疼痛视觉模拟评分（VAS）、Ramsay镇静评分、胎心率（FHR）及新生儿Apgar评分、脐动脉血气分析值等，评估其对产妇及新生儿的安全性的影响。结果　本研究最终纳入91例产妇，年龄20~36岁。与对照组（45例）相比，观察组（46例）爆发痛发生率显著降低，首次爆发痛发生时间显著推迟，PCEA次数与镇痛药总量显著减少，产妇满意度显著增高， T1~3时VAS评分显著降低，Ramsay评分显著增高（P＜0.05）。2组产程时间、FHR、新生儿Apgar评分、脐动脉血气分析值及不良反应发生率差异均无统计学意义（P＞0.05）。结论　右美托咪定滴鼻用于硬膜外分娩镇痛可降低爆发痛发生率，推迟首次爆发痛发生时间，减少局麻药用量，对产妇和新生儿无明显不良影响。

关键词: 分娩疼痛, 爆发性疼痛, 镇痛, 产科, 镇痛, 硬膜外, 右美托咪定, 投药, 鼻内

Abstract: Objective　To investigate the effect of intranasal dexmedetomidine on preventing breakthrough pain of epidural labor analgesia. Methods　Full-term primigravida with singleton fetus and ASA physical status Ⅰ or Ⅱ (n=100) were randomly assigned to control group and intranasal dexmedetomidine group (observation group). The 0.8 µg/kg of dexmedetomidine or equal volume normal saline were administered intranasally 20 minutes after epidural analgesia for observation group and control group, respectively. The incidence of breakthrough pain, the duration from epidural analgesia to the first onset of breakthrough pain, the frequency of patient controlled epidural analgesia (PCEA), the total dosage of analgesics, the maternal satisfaction with analgesia and the duration of labor phrase were recorded. The effect of intranasal dexmedetomidine on breakthrough pain of epidural labor analgesia was evaluated. The VAS scores, the Ramsay scores and FHR before epidural analgesia (T0), and after epidural analgesia at 1 h (T1), 2 h (T2), 3 h (T3), 4 h (T4), full cervical dilation (T5), fetal disengagement (T6), Apgar scores of neonates and umbilical artery blood gas analysis were recorded in the two groups to assess the effect of maternal and neonatal safety. Results　A total of 91 parturients aged 20 to 36 years were included in this study. Compared with the control group (n=45) , the incidence of breakthrough pain was significantly reduced, the duration from epidural analgesia to the first onset of breakthrough pain was significantly prolonged, the frequency of PCEA and the total dosage of analgesics was significantly reduced, the maternal satisfaction with analgesia was significantly increased, the VAS scores were significantly decreased at T1~3 and the Ramsay scores were significantly increased at T1~3 in the observation group (n=46, P＜0.05). There were no significant differences in the duration of labor phrase, FHR, Apgar scores of neonates, umbilical artery blood gas analysis and the adverse reactions between the two groups (P＞0.05). Conclusion　Intranasal dexmedetomidine for epidural labor analgesia can reduce the incidence of breakthrough pain, delay the first onset of breakthrough pain, decrease the dosage of local anesthetic, and have no obvious adverse effects on parturients and newborns.

Key words: labor pain, breakthrough pain, analgesia, obstetrical, analgesia, epidural, dexmedetomidine, administration, intranasal