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目的探讨硬膜外自控镇痛(PCEA)规律间断注入联合静脉输注右美托咪定用于分娩镇痛的效果及临床相关分析。方法选取在武汉市第六医院接受分娩镇痛的90例初产妇为研究对象,随机分为联合组和对照组,每组各45例。联合组实施PCEA规律间断注入联合右美托咪定静脉输注镇痛,对照组采用单纯PCEA规律间断注入镇痛。比较两组产妇的各时点VAS评分、镇痛维持时间、硬膜外药物用量、产程、分娩方式、不良反应、新生儿Apgar评分,以及镇痛前与分娩后的凝血功能[活化部分凝血活酶时间(APTT)、血浆凝血酶原时间(PT)、纤维蛋白原(FIB)]及血浆儿茶酚胺[去甲肾上腺素(NA)、肾上腺素(Adr)]水平。结果实施分娩镇痛后的各时点两组产妇的VAS评分均较镇痛前显著下降,且联合组在镇痛后各时点的VAS评分明显小于对照组,镇痛维持时间显著长于对照组(P<0.05);两组产妇的第一产程、分娩方式、不良反应及新生儿Apgar评分比较,差异均无统计学意义(P>0.05),但联合组产妇的第二产程、第三产程及硬膜外药物用量明显小于对照组(P<0.05);分娩后两组产妇的APTT、PT、Adr及NA数值均较镇痛前显著下降,FIB数值较镇痛前显著上升(均P<0.05)。结论 PCEA规律间断注入联合右美托咪定静注方式用于分娩镇痛的效果更好,不仅缩短了产程时间,还能减少硬膜外药物用量,改善分娩后高凝状态,降低血浆儿茶酚胺浓度,安全可靠。
Objective To investigate the effect of intermittent intravenous epidural analgesia (PCEA) intermittent infusion and intravenous infusion of dexmedetomidine on labor analgesia and its clinical correlation analysis. Methods Ninety cases of primiparous women receiving labor analgesia in the sixth hospital of Wuhan were selected as study objects and randomly divided into the combined group and the control group, with 45 cases in each group. Combined group implementation of PCEA regular intermittent injection of dexmedetomidine intravenous injection of analgesia, the control group using simple PCEA regular intermittent injection of analgesia. VAS score, duration of analgesia, dosage of epidural drug, labor, mode of delivery, adverse reactions, neonatal Apgar score, and blood coagulation function before and after labor analgesia were compared between the two groups APTT, PT, FIB and plasma levels of catecholamines, norepinephrine and adrenaline. Results The VAS score of maternal women in each group was significantly lower than that before analgesia at each time point after delivery analgesia. The VAS scores of the combined group at the time points after analgesia were significantly lower than those in the control group, and the duration of analgesia maintenance was significantly longer than that of the control group (P <0.05). There was no significant difference in the first stage of labor, mode of delivery, adverse reactions and neonatal Apgar score between the two groups (P> 0.05). However, the second and third stage of labor (P <0.05). The values of APTT, PT, Adr and NA of the two groups after labor were significantly lower than those before analgesia, and the values of FIB were significantly higher than those before analgesia (all P < 0.05). Conclusion PCEA intermittent injection combined with dexmedetomidine intravenous injection for labor analgesia is better, not only shorten the labor time, but also reduce the amount of epidural drug, improve hypercoagulability after delivery, reduce plasma catecholamine concentration ,Safe and reliable.