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罗哌卡因联合右美托咪定在剖宫产术后去阿片化镇痛中的应用
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| 篇名： | 罗哌卡因联合右美托咪定在剖宫产术后去阿片化镇痛中的应用 |
| TITLE： | Application of ropivacaine combination with dexmedetomidine in opioid-free analgesia after cesarean section |
| 摘要： | 目的 考察罗哌卡因联合右美托咪定对剖宫产产妇的术后镇痛效果，探讨腰硬联合麻醉下剖宫产术后去阿片化镇痛模式的可行性。方法80例剖宫产产妇随机分为观察组（采用罗哌卡因联合右美托咪定镇痛）和对照组（采用罗哌卡因联合阿片类药物舒芬太尼镇痛）各40例。比较两组产妇术后48h内视觉模拟评分（VAS）中的运动评分和静息评分、镇痛泵使用情况（首次镇痛泵按压时间、术后24h内和48h内镇痛泵按压次数）、阻滞时效（腰麻感觉阻滞起效时间、腰麻感觉阻滞达最高平面的时间、感觉恢复时间和运动恢复时间）、预后时间（胃肠通气恢复时间、开始下床时间和住院时间）以及不良反应发生情况。结果最终有64例产妇（观察组32例、对照组32例）进入比较研究。与对照组相比，观察组产妇感觉恢复时间和运动恢复时间显著延长，胃肠通气恢复时间显著缩短，恶心呕吐和腹胀的发生率显著降低（P＜0.05）；两组其余指标比较，差异均无统计学意义（P＞0.05）。结论腰硬联合麻醉下罗哌卡因联合右美托咪定可提供与联合阿片类药物舒芬太尼相当的镇痛效果，并可缩短产妇胃肠通气恢复时间，降低恶心呕吐和腹胀的发生率，同时不增加低血压和尿潴留风险。 |
| ABSTRACT： | OBJECTIVE To investigate the effect of ropivacaine combined with dexmedetomidine on postoperative analgesia in women undergoing cesarean section， and to explore the feasibility of the opioid-free analgesia mode after cesarean section under spinal-epidural anesthesia. METHODS Totally 80 women undergoing cesarean section were randomly divided into observation group （ropivacaine combined with dexmedetomidine for analgesia） and control group （ropivacaine combined with opioid drug sufentanil for analgesia） ， with 40 cases in each group. The exercise and rest score in visual analogue scale （VAS） within 48 hours after operation， the use of analgesia pump （the time of first analgesia pump pressing， the times of analgesia pump pressing within 24 hours and 48 hours after operation）， the time of block （the onset time of spinal anesthesia sensory block， the time to the highest level of spinal anesthesia sensory block， the time of sensory recovery and the time of movement recovery） ， the time of prognosis （the time of gastrointestinal ventilation recovery， the time of getting out of bed and the hospitalization time）， and the incidence of adverse events were compared in 2 groups. RESULTS Finally， 64 parturients （32 in the observation group and 32 in the control group） were involved in the analysis. Compared with the control group， the recovery time of sensation and movement were significantly prolonged， the ventilation time was significantly shortened， and the incidence of nausea， vomiting and abdominal distension was significantly decreased in the observation group （P＜0.05） . There was no significant difference in the other indexes between the two groups （P＞0.05）. CONCLUSIONS Ropivacaine combined with dexmedetomidine under spinal-epidural anesthesia could provide similar analgesic effect as combined with opioids drug sufentanil， shorten the time of gastrointestinal ventilation recovery， and reduce the incidence of nausea，vomiting and abdominal distension， with no increased risk of low blood pressure or urinary retention. |
| 期刊： | 2023年第34卷第01期 |
| 作者： | 刘坤山；李孟迪；赵建军；程新琦 |
| AUTHORS： | LIU Kunshan，LI Mengdi，ZHAO Jianjun，CHENG Xinqi |
| 关键字： | 腰硬联合麻醉；罗哌卡因；右美托咪定；去阿片化镇痛；剖宫产术 |
| KEYWORDS： | spinal-epidural anesthesia； ropivacaine； dex- |
| 阅读数： | 167 次 |
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