Efficacy of dexmedetomidine mixed with ropivacaine for programmed intermittent epidural bolus technique on labor analgesia and intrapartum maternal hyperthermia
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摘要:
目的：评价右美托咪定(dexmedetomidine，Dex)混合罗哌卡因用于程控硬膜外间歇脉冲式分娩镇痛的效果及对产时发热的影响。方法：选择单胎足月妊娠初产妇104例，随机数表法分为0.1%罗哌卡因混合0.5 μg/mL右美托咪定组(RD组，n= 52)和0.1%罗哌卡因混合1 μg/mL芬太尼组(RF组，n=52)。两组患者均接受程控硬膜外间歇脉冲式分娩镇痛。记录分娩镇痛前(T0)、给予负荷量后30 min(T1)、1 h(T2)、2 h(T3)、4 h(T4)、6 h(T5)、宫口开全时(T6)、胎儿娩出后2 h(T7)8个时点的疼痛视觉模拟评分(visual analogue scale，VAS)、鼓膜温度。记录爆发痛、不良反应和新生儿1 min、5 min Apgar评分。于T0和T7时点抽取患者非输液侧静脉血，检测白细胞计数和C反应蛋白水平。结果：RD组镇痛起效时间短于RF组(5.9 min vs. 8.7 min)；RD组 T2~T6时点的VAS评分分别低于RF组(P＜0.05)；RD组爆发痛的发生率低于RF组(4.1% vs. 20.0%)(P＜0.05)。RD组患者的发热率低于RF组(8.2% vs. 38.0%)(P＜0.05)；T4~T7时点，RD组的鼓膜温度分别低于RF组(P＜0.05)。与T0时比较，两组患者T7 时的白细胞计数和C反应蛋白均明显升高(P＜0.01)，而组间比较，差异无统计学意义(P ＞ 0.05)。RD组皮肤瘙痒的发生率低于RF组(P＜0.05)。结论：右美托咪定可增强罗哌卡因硬膜外分娩镇痛的效果，降低硬膜外分娩镇痛相关产时发热的几率和程度，而对母婴无不良影响。
Abstract:
Objective：To evaluate the effects of dexmedetomidine mixed with ropivacaine for programmed intermittent epidural bolus technique on labor analgesia and intrapartum maternal hyperthermia. Methods：A total of 104 singleton full-term parturients，of American Society of Anesthesiologists physical status Ⅰ or Ⅱ，aged 20~35 years，weighing 60~85 kg，scheduled for elective labor analgesia，were divided into 0.1% ropivacaine mixed with 0.5 μg/ml dexmedetomidine(group RD，n=52)and 0.1% ropivacaine mixed with 1 μg/mL fentanyl(group RF，n=52)by a random number table method. Both groups received programmed intermittent epidural bolus technique in labor analgesia. The visual analogue scale(VAS)score and the maternal temperature were measured before anesthesia(T0)，at 30 min(T1)，1 h(T2)，2 h(T3)，4 h(T4)，6 h(T5)post analgesia，10 cm cervical dilatation(T6)and 2 h after delivery (T7). Recording the incidence of breakthrough pain and the adverse effects，the Apgar scores were evaluated at 1 min and 5 min after the delivery. Venous blood samples were collected in non-infusion sides at T0 and T7 to detect the maternal white blood cell count and serum C-reactive protein. Results：Compared with group RF，the onset time of analgesia was significantly shortened，the VAS scores at T2~6 and the incidence of breakthrough pain(4.1% vs. 20.0%)were lower in group RD(P ＜ 0.05). The incidence of intrapartum fever was lower in group RD(8.2% vs. 38.0%)，and also the maternal temperature at T4~7 than those in group RF. Compared with T0，the maternal white blood cell count and C - reactive protein at T7 were significantly higher in both groups（P < 0.01），but there were no significant differences between the two groups at T0 and T（7 P > 0.05）. The incidence of pruritus was lower in the group RD compared to group RF（P < 0.05）. Conclusion：Dexmedetomidine may enhance the efficacy of epidural labor analgesia with ropivacaine and reduce the rate and degree of intrapartum maternal hyperthermia associated with epidural labor analgesia without increasing adverse effects on mother and infant.
