邹翠芸 罗惠莲 彭燕 杜浩文

【摘要】 目的：分析右美托咪定联合罗哌卡因用于阴部神经阻滞临床效果。方法：选取2019年2月-2020年6月本院收治的210例经阴道分娩且行会阴侧切术的足月单活胎初产妇为研究对象，按照随机数字表法将其均分为A、B、C三组，各70例。A组给予利多卡因，B组给予罗哌卡因，C组给予右美托咪定联合罗哌卡因，比较三组产妇产后疼痛情况、血压、心率、皮质醇、多巴胺、去甲肾上腺素水平、不良反应及产妇满意度。结果：C组产后各时间段疼痛评分均低于A、B组（P<0.05），C组产后收缩压、舒张压均低于A、B组（P<0.05），C组产后心率均低于A、B组（P<0.05）。C组产后2、24 h多巴胺、皮质醇、去甲肾上腺素均低于A、B组（P<0.05）。C组产后不良反应发生率均低于A、B组（P<0.05），C组满意度评分均高于A、B组（P<0.05）。结论：右美托咪定联合罗哌卡因用于阴部神经阻滞可减轻产妇产后疼痛及应激反应，降低产妇不良反应，提高产妇满意度。

【关键词】 右美托咪定 神经阻滞 疼痛情况 罗哌卡因

[Abstract] Objective： To analyze the clinical effect of Dexmedetomidine combined with Ropivacaine for pudendal nerve block. Method： A total of 210 cases of full-term primiparas with single live fetus who underwent perineal lateral resection after vaginal delivery in our hospital from February 2019 to June 2020 were selected as the research objects， according to the random number table method， they were divided into group A， B and C， 70 cases in each group. Group A was given Lidocaine， group B was given Ropivacaine， group C was given Dexmedetomidine combined with Ropivacaine. Postpartum pain， blood pressure， heart rate， cortisol， dopamine， norepinephrine levels， adverse reactions and maternal satisfaction were compared among three groups. Result： The postpartum pain scores of group C were lower than those of group A and B at various time periods （P<0.05）， the postpartum systolic and diastolic blood pressure of group C were lower than those of group A and B （P<0.05）， the postpartum heart rate of group C was lower than that of group A and B （P<0.05）. Dopamine， cortisol and norepinephrine in group C at postpartum 2 and 24 h were lower than that in group A and B （P<0.05）. The incidence of postpartum adverse reactions in group C was lower than those in group A and B （P<0.05）， the satisfaction score in group C was higher than that in group A and B （P<0.05）. Conclusion： Dexmedetomidine combined with Ropivacaine for pudendal nerve block can reduce postpartum pain and stress response， reduce maternal adverse reactions， improve maternal satisfaction.

[Key words] Dexmedetomidine Nerve block Pain condition Ropivacaine

First-authors address： Huizhou Second Maternal and Child Health Hospital， Huizhou 516001， China

doi：10.3969/j.issn.1674-4985.2021.09.021

初產妇经阴道分娩常伴有不同程度阴道软组织损伤甚至会阴撕裂从而导致产后阴部疼痛[1]，严重影响产妇早期康复、生活质量及心理健康，因此亟需寻找合适神经阻滞方案以减轻初产妇顺利分娩后阴部疼痛情况促进产后康复。目前临床常用利多卡因进行阴部神经阻滞，但是由于利多卡因作用时间短暂部分产妇术后可产生严重疼痛[2]。研究表明罗哌卡因麻醉强度高于利多卡因且镇痛时间较长，右美托咪定在镇痛的同时还可减轻应激反应并抗焦虑[3]，两药联合应用在股神经、臂丛神经、椎管内阻滞方面效果良好[4]，但是对于初产妇阴部神经阻滞研究较少，近年来笔者在临床中发现两药联合应用于阴部神经阻滞效果良好，今为进一步探讨右美托咪定联合罗哌卡因用于阴部神经阻滞对患者疼痛及应激反应影响，遂进行本次研究，现报道如下。……