摘要
目的观察不同剂量右美托咪定联合羟考酮对剖宫产术后镇痛及泌乳的影响。方法选取2022年2月—2024年2月于福建省漳州市医院行剖宫产的产妇120例,采用随机数字表法分为甲组、乙组和丙组,每组40例。3组均于胎儿娩出后给予静脉镇痛泵,镇痛配方:在舒芬太尼2μg/kg+昂丹司琼16 mg+羟考酮0.4 mg/kg的基础上,甲组给予低剂量(1μg/kg)右美托咪定,乙组给予中剂量(2μg/kg)右美托咪定,丙组给予高剂量(4μg/kg)右美托咪定。比较3组各时点动态及静息状态下视觉模拟评分法(VAS)评分、泌乳情况[催乳素(PRL)水平、首次泌乳时间]、阿森斯失眠量表(AIS)评分,不良反应。结果乙组及丙组术后6、12、24 h动态VAS评分均低于同时点甲组,乙组术后12、24 h静息状态VAS评分及丙组术后6、12、24 h静息状态VAS评分均低于同时点甲组(P<0.05);乙组与丙组术后6、12、24 h动态及静息状态VAS评分比较无显著差异(P>0.05)。术前及术后1、2、3 d,3组PRL水平逐渐升高(P<0.05);术后1、2、3 d,乙组及丙组PRL水平高于同时点甲组(P<0.05),乙组与丙组PRL水平比较无显著差异(P>0.05)。乙组及丙组首次泌乳时间早于甲组(F=2.745,P=0.007),乙组与丙组首次泌乳时间比较无显著差异(P>0.05)。术前及术后1、2 d,3组AIS评分先升高再降低(P<0.05);术后1、2 d,3组AIS评分比较无显著差异(P>0.05)。乙组与甲组及丙组与乙组不良反应总发生率比较无显著差异(P>0.05),丙组不良反应总发生率高于甲组(χ^(2)=6.384,P=0.041)。结论中剂量右美托咪定联合羟考酮的镇痛效果较好,可改善睡眠质量,促进泌乳,且不会增加不良反应。
Objective To observe the effects of different doses of dexmedetomidine combined with oxycodone on analgesia and lactation after cesarean section.Methods A total of 120 women who underwent cesarean section in Zhangzhou Hospital of Fujian Province from February 2022 to February 2024 were selected and divided into groups A,B and C by random number table method,with 40 cases in each group.All the three groups were given intravenous analgesic pump after delivery.The analgesic formula was as follows:On the basis of Sufentanil 2μg/kg+ondansetron 16 mg+oxycodone 0.4 mg/kg,group A was given a low dose(1μg/kg)of dexmedetomidine,group B was given a medium dose(2μg/kg)of dexmedetomidine,group C was given a high dose(4μg/kg)of dexmedetomidine.VAS scores at different time points in dynamic and resting states,lactation(PRL level,time of first lactation),AIS scores and adverse reactions were compared between the three groups.Results The dynamic VAS scores of group B and group C at 6,12 and 24 h after surgery were lower than those of group A simultaneously,and the resting VAS scores of group B at 12 and 24 h after surgery and those of group C at 6,12 and 24 h after surgery were lower than those of group A simultaneously(P<0.05).There was no significant difference in dynamic and resting VAS scores between group B and group C at 6,12 and 24 h after surgery(P>0.05).The level of PRL in 3 groups was increased gradually before surgery and 1,2 and 3 days after surgery(P<0.05).On day 1,2 and 3 after surgery,the PRL level of group B and group C was higher than that of group A(P<0.05),but there was no significant difference between group B and group C(P>0.05).The time of first lactation in group B and group C was earlier than that in group A(F=2.745,P=0.007),and there was no statistical significance in the time of first lactation between group B and group C(P>0.05).The AIS score of 3 groups was firstly increased and then decreased before surgery and 1 and 2 days after surgery(P<0.05).There was no significant difference in AIS score among 3 groups 1 and 2 days after surgery(P>0.05).There was no significant difference in the total incidence of adverse reactions between group B and group A,and between group C and group B(P>0.05),but the total incidence of adverse reactions in group C was higher than that in group A(χ^(2)=6.384,P=0.041).Conclusion Middose dexmedetomidine combined with oxycodone has better analgesic effect,can improve sleep quality,promote lactation,and does not increase adverse reactions.
作者
苏春婷
SU Chunting(Zhangzhou Hospital,Fujian Province,Zhangzhou 363000,China)
出处
《临床合理用药杂志》
2024年第29期31-33,37,共4页
Chinese Journal of Clinical Rational Drug Use
关键词
右美托咪定
不同剂量
羟考酮
剖宫产
术后镇痛
泌乳
Dexmedetomidine,different doses
Oxycodone
Cesarean section
Postoperative analgesia
Lactation
