右美托咪定复合曲马多用于剖宫产术后产妇自控镇痛的效果
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摘要
目的评价右美托咪定复合曲马多用于剖宫产术后镇痛的效果。方法择期行剖宫产产妇150例,数字随机表法随机分为3组:Ⅰ组于胎儿取出后静脉注射生理盐水20 ml,术后静脉自控镇痛(PCIA)药物配方为曲马多1 g,生理盐水稀释至100 ml,设置背景输注剂量为1.5 ml/h,PCA 2 ml,锁定时间15 min;Ⅱ组于胎儿取出后静脉注射右美托咪定0.3μg/kg,生理盐水稀释至20 ml,微泵10 min静脉推注完毕,术后PCIA配方和设置同Ⅰ组。Ⅲ组于胎儿取出后静脉微泵推注右美托咪定0.3μg/kg,使用方法同Ⅱ组,术后PCIA配方为曲马多1 g+右美托咪定200μg,生理盐水稀释至100 ml,术后PCIA设置同Ⅰ组。观察术后4、8、24 h VAS评分、Ramsay镇静评分和曲马多的用量;观察术后6 h恶露排除量和泌乳开始时间;记录24 h内心动过缓、低氧血症、恶心、呕吐、眩晕等并发症的发生情况和产妇对术后镇痛的满意度。结果 3组产妇一般情况无统计学意义,均完成了24 h镇痛观察,没有产妇需要额外的镇痛治疗。与Ⅰ、Ⅱ组比较,Ⅲ组术后4、8、24 h VAS评分和曲马多用量降低,产妇满意度提高(P<0.05);三组产妇术后6 h恶露排出量,产后泌乳开始(挤压双侧乳房有明显乳汁泌出)时间无统计学意义;三组产妇术后各时间点Ramsay评分有所不同,但无统计学意义,术后均未发生心动过缓、低氧血症、恶心呕吐等副作用,Ⅰ组、Ⅱ组、Ⅲ组各有5、1、0例产妇术后第一次起床时出现眩晕症,未特殊处理,休息后好转。结论右美托咪定复合曲马多用于择期剖宫产术后静脉镇痛效果优于单独使用曲马多。
Objective To evaluate the efficacy of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia(PCIA) after cesarean section.Methods One hundred and fifty patients undergoing elective cesarean section were randomly allocated into 3 groups with 50 cases in each group.Immediately after delivery,a bolus of dexmedetomidine 0.3 μg / kg was given intravenously in 10 min in group Ⅱ and group Ⅲ,while normal saline(NS) was given in group Ⅰinstead.Group Ⅰ and group Ⅱ received PCIA with tramadol 1 g diluted by NS into 100 ml(background infusion 2 ml/h;PCA 2 ml;lockout interval 15 min);group Ⅲ received PCIA with dexmedetomidine 200 μg combined with tramadol 1 g diluted by NS into 100 ml(background infusion2 ml / h;PCA 2 ml;lockout interval 15 min).VAS scores,Ramsay scores and consumption of tramadol were measured 4,8 and 24 h after surgery.The volume of lochia 6 h after surgery and the time of breast milk secretion were recorded.The side effects like bradycardia,hypoxemia,nausea,vomiting and dizzy 24 h after surgery were also recorded.The degree of satisfaction of post-operative analgesia was documented.Results There were no statistical differences in patients demographics among three groups,and no patient needed extra analgesia.The VAS scores and the consumption of tramadol of 4,8 and 24 h were lower and the degree of satisfaction was higher in group Ⅲ than those in groupⅠand group Ⅱ(all P < 0.05).There were no statistical differences in volume of lochia and the time of milk secretion among 3 groups.Ramsay scores were 2 at all time points in thee groups.No side effects like bradycardia,hypoxemia,nausea,vomiting and dizzy were observed after surgery.Conclusion Dexmedetomidine combined with tramadol offers better analgesic effect than single use of tramadol after cesarean section.
Objective To evaluate the efficacy of dexmedetomidine combined with tramadol for patient-controlled intravenous analgesia(PCIA) after cesarean section.Methods One hundred and fifty patients undergoing elective cesarean section were randomly allocated into 3 groups with 50 cases in each group.Immediately after delivery,a bolus of dexmedetomidine 0.3 μg / kg was given intravenously in 10 min in group Ⅱ and group Ⅲ,while normal saline(NS) was given in group Ⅰinstead.Group Ⅰ and group Ⅱ received PCIA with tramadol 1 g diluted by NS into 100 ml(background infusion 2 ml/h;PCA 2 ml;lockout interval 15 min);group Ⅲ received PCIA with dexmedetomidine 200 μg combined with tramadol 1 g diluted by NS into 100 ml(background infusion2 ml / h;PCA 2 ml;lockout interval 15 min).VAS scores,Ramsay scores and consumption of tramadol were measured 4,8 and 24 h after surgery.The volume of lochia 6 h after surgery and the time of breast milk secretion were recorded.The side effects like bradycardia,hypoxemia,nausea,vomiting and dizzy 24 h after surgery were also recorded.The degree of satisfaction of post-operative analgesia was documented.Results There were no statistical differences in patients demographics among three groups,and no patient needed extra analgesia.The VAS scores and the consumption of tramadol of 4,8 and 24 h were lower and the degree of satisfaction was higher in group Ⅲ than those in groupⅠand group Ⅱ(all P < 0.05).There were no statistical differences in volume of lochia and the time of milk secretion among 3 groups.Ramsay scores were 2 at all time points in thee groups.No side effects like bradycardia,hypoxemia,nausea,vomiting and dizzy were observed after surgery.Conclusion Dexmedetomidine combined with tramadol offers better analgesic effect than single use of tramadol after cesarean section.
引文
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[3]Angst MS,Ramaswamy B,Davies MF,et al.Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans[J].Anesthesiology,2004,101(3):744-752.
[4]Palanisamy A,Klickovich RJ,Ramsay M,et al.Intravenous dexmedetomidine as an adjunct for labor analgesia and cesarean delivery anesthesia in a parturient with a tethered spinal cord.Int J[J].Obstet Anesth,2009,18(3):258-261.
[5]Yuyan N,Yuqi L,Qingyan L,et al.Effect of dexmedtomidine combined with sufentanil for postcaesarean section intravenous analgesia[J].Eur J Anaesthesiol,2014,31:197-203.
[6]Lin TF,Yeh YC,Lin FS,et al.Effect of combining dexmedetomidine and morphine for intravenous patientcontrolled analgesia[J].Br J Anesth,2009,102(1):117-122.
[7]Akbay BK,Yildizbas S,Gualu E,et al.Analgesic efficacy of topical tramadol in the control in the of posyoperative pain in children after tonsillectomy[J].J Anesth,2010,24:705-708.
[2]Stemp LI,Karras GE JR.Dexmedetomidine facilitates withdrawal of ventilatory support[J].Anesthesiology,2006,104(4):890.
[3]Angst MS,Ramaswamy B,Davies MF,et al.Comparative analgesic and mental effects of increasing plasma concentrations of dexmedetomidine and alfentanil in humans[J].Anesthesiology,2004,101(3):744-752.
[4]Palanisamy A,Klickovich RJ,Ramsay M,et al.Intravenous dexmedetomidine as an adjunct for labor analgesia and cesarean delivery anesthesia in a parturient with a tethered spinal cord.Int J[J].Obstet Anesth,2009,18(3):258-261.
[5]Yuyan N,Yuqi L,Qingyan L,et al.Effect of dexmedtomidine combined with sufentanil for postcaesarean section intravenous analgesia[J].Eur J Anaesthesiol,2014,31:197-203.
[6]Lin TF,Yeh YC,Lin FS,et al.Effect of combining dexmedetomidine and morphine for intravenous patientcontrolled analgesia[J].Br J Anesth,2009,102(1):117-122.
[7]Akbay BK,Yildizbas S,Gualu E,et al.Analgesic efficacy of topical tramadol in the control in the of posyoperative pain in children after tonsillectomy[J].J Anesth,2010,24:705-708.