标题：不同剂量右美托咪定腹横肌平面阻滞对剖宫产术后产妇镇痛效果及泌乳功能的影响

      作者：王平，沈刚，徐德芬    南京市中医药大学江阴附属医院麻醉科，江苏 无锡 214400

      卷次： 2021年32卷18期

      【摘要】 目的 比较不同剂量右美托咪定复合罗哌卡因用于腹横肌平面阻滞对剖宫产术后产妇镇痛效果及泌乳功能的影响。方法 选择南京中医药大学江阴附属医院2019年6月至2020年6月择期行剖宫产手术的产妇120例，按照随机数表法分为A、B、C三组，每组40例，所有产妇剖宫产术后行超声引导下双侧腹横肌平面阻滞，A组给予0.375%罗哌卡因30 mL+生理盐水20 mL，B组给予0.375%罗哌卡因30 mL+0.5 μg/kg右美托咪定20 mL，C组给予0.375%罗哌卡因30 mL+1 μg/kg右美托咪定20 mL，所有产妇术后均行配方相同的静脉自控镇痛，比较三组产妇术后 2 h、6 h、12 h、24 h、48 h的镇痛效果(VAS评分)及术后第一天 24 h镇痛泵按压次数及舒芬太尼消耗量总量、初乳分泌时间及术后24 h、48 h的血清泌乳素水平和术后不良反应等情况。结果 A组产妇术后6 h、12 h、24 h的VAS评分明显高于B组和C组，差异有统计学意义(P<0.05)；B组与C组产妇术后24 h镇痛泵有效按压次数分别为(9.7±1.7)次、(9.4±1.5)次，明显少于A组的(15.0±3.0)次，差异有统计学意义(P<0.05)；B组与C组产妇术后24 h的舒芬太尼消耗量分别为(62.6±2.6) μg、(62.1±2.2) μg，明显低于A组的(70.5±4.4) μg，差异有统计学意义(P<0.05)，而B组与C组组间比较差异无统计学意义(P>0.05)；产妇术后24 h、48 h的血清泌乳素水平，A组明显低于B组和C组，差异有统计学意义(P<0.05)；A组产妇的初乳分泌时间为(29.0±3.1) min，明显高于B组的(25±2.6) min和C组的(24.3±3.2) min，差异有统计学意义(P<0.05)，B组与C组产妇组间比较差异无统计学意义(P>0.05)；A组产妇的恶心呕吐比例为15.0%，明显高于B组的2.5%和C组的2.5%，差异有统计学意义(P<0.05)，C组产妇的心动过缓比例为10.0%，明显高于A组(0)和B组(0)，差异有统计学意义(P<0.05)。结论 剖宫产术后采用0.5 μg/kg右美托咪定复合罗哌卡因在超声引导下行腹横肌平面阻滞可以有效减轻产妇疼痛、减少阿片药物的使用、促进产妇泌乳功能恢复、不良反应较少，值得临床推广应用。
      【关键词】 右美托咪定；罗哌卡因；腹横肌平面阻滞；剖宫产术；镇痛效果；泌乳
      【中图分类号】 R719.8 【文献标识码】 A 【文章编号】 1003—6350（2021）18—2365—04

Clinical efficacy of different dosage of dexmedetomidine for transversus abdominis plane block on postoperativeanalgesia after cesarean section and its influence on lactation.
WANG Ping, SHEN Gang, XU De-fen. Department ofAnesthesiology, Jiangyin Hospital of Nanjing University of Traditional Chinese Medicine, Wuxi 214400, Jiangsu, CHINA
【Abstract】 Objective To explore the efficacy of different dosage of dexmedetomidine plus ropivacaine in thetreatment of postoperative analgesia after cesarean section and its influence on lactation. Methods A total of 120 partu-rients who were scheduled for cesarean section were randomly divided into three groups, with 40 cases in each group.All parturients underwent ultrasound-guided bilateral transverse abdominal plane block after cesarean section. Patients ingroup A were given 0.375% ropivacaine 30 mL+normal saline (NS) 20 mL, patients in group B were given 0.375% ropi-vacaine 30 mL+0.5 μg/kg dexmedetomidine 20 mL, and group C was given 0.375% ropivacaine 30 mL+1 μg/kg dexme-detomidine 20 mL. All patients were given patient-controlled intravenous analgesia with the same formula after the oper-ation. Visual analogue scale (VAS) scores at 2 h, 6 h, 12 h, 24 h, and 48 h after the operation, pressing times of analgesiapump and consumption of sufentanil within postoperative 24 h, colostrum time, serum prolactin levels at 24 h and 48 hafter operation, and postoperative adverse reactions were observed and compared among three groups. Results VASscores of group A at 6 h, 12 h and 24 h after operation were significantly higher than those of group B and group C (P<0.05). The effective pressing times of analgesia pump in group B and group C within 24 hours after operation were 9.7±1.7 and 9.4±1.5, significantly lower than 15.0±3.0 in group A (P<0.05). The consumption of sufentanil in group B andgroup C within 24 hours after operation were (62.6±2.6) μg and (62.1±2.2) μg, respectively, significantly lower than(70.5±4.4) μg in group A (P<0.05), and there was no statistically significant difference in consumption of sufentanil be-tween group B and group C (P>0.05). The levels of serum prolactin in group at 24 h and 48 h after operation were signifi-cantly lower than in group A than in group B and C (P<0.05); the colostrum secretion time in group A was (29.0±3.1) min,