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地塞米松作为鞘内分娩镇痛辅助药物的影响:一项关于疗效和产妇满意度的多中心研究。

The Influence of Dexmedetomidine as an Adjuvant in Intrathecal Labor Analgesia: A Multicenter Study on Efficacy and Maternal Satisfaction.

机构信息

Department of Anesthesiology, Nanning Maternal and Child Health Hospital, Nanning, China.

Department of Obstetrics, Nanning Maternal and Child Health Hospital, Nanning, China.

出版信息

J Clin Pharmacol. 2024 Jan;64(1):111-117. doi: 10.1002/jcph.2335. Epub 2023 Aug 31.

Abstract

In this study, we examined the impact of dexmedetomidine (DEX) on the effectiveness of epidural analgesia and labor outcomes. We administered different doses of DEX combined with 0.1% ropivacaine for epidural analgesia to evaluate the clinical effects and safety. To assess the effects of different concentrations of DEX in parturient women receiving epidural analgesia, we conducted a randomized double-blind trial. We selected 400 parturient women and randomly assigned them to 4 groups, with 100 parturient women in each group: S0.1 (0.1 µg/mL DEX), S0.2 (0.2 µg/mL DEX), S0.3 (0.3 µg/mL DEX), and a control group (0.3 µg/mL sufentanil). Post-analgesia, we recorded the Bromage score, duration of labor, method of delivery, bleeding, neonatal Apgar score, adverse reactions, and maternal satisfaction. The number of patients with a Bromage score of ≥2 and the incidence of bradycardia were higher in the S0.3 group compared with the other 3 groups (P < .05), whereas the high satisfaction rate was lower in the S0.3 group (P < .05). Moreover, we found that the number of times that additional patient-controlled analgesia was administered was higher in the S0.1 group compared with the remaining 3 groups (P < .05). The control group exhibited a higher incidence of pruritus than the other 3 groups (P < .05). In conclusion, when administering spinal anesthesia for the relief of labor pain, epidural analgesia with 0.1% ropivacaine combined with 0.2 µg/mL DEX provides relatively ideal analgesic effects, higher maternal satisfaction, and reduces the incidence of pruritus, compared with the combination of 0.1% ropivacaine and 0.3 µg/mL sufentanil.

摘要

在这项研究中,我们考察了右美托咪定(DEX)对硬膜外镇痛效果和分娩结局的影响。我们给予不同剂量的 DEX 与 0.1%罗哌卡因联合用于硬膜外镇痛,以评估其临床效果和安全性。为了评估不同浓度的 DEX 对接受硬膜外镇痛的产妇的影响,我们进行了一项随机双盲试验。我们选择了 400 名产妇,并将其随机分为 4 组,每组 100 名产妇:S0.1(0.1μg/mL DEX)、S0.2(0.2μg/mL DEX)、S0.3(0.3μg/mL DEX)和对照组(0.3μg/mL 舒芬太尼)。镇痛后,我们记录了 Bromage 评分、产程时间、分娩方式、出血、新生儿 Apgar 评分、不良反应和产妇满意度。与其他 3 组相比,S0.3 组 Bromage 评分≥2 的患者数量和心动过缓的发生率更高(P<0.05),而 S0.3 组的高满意度较低(P<0.05)。此外,我们发现 S0.1 组需要额外给予患者自控镇痛的次数比其他 3 组更多(P<0.05)。对照组瘙痒的发生率高于其他 3 组(P<0.05)。总之,在缓解分娩疼痛时行脊髓麻醉,0.1%罗哌卡因联合 0.2μg/mL DEX 行硬膜外镇痛的镇痛效果较理想,产妇满意度较高,且瘙痒的发生率较低,优于 0.1%罗哌卡因联合 0.3μg/mL 舒芬太尼。

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