【罂粟摘要】硬膜外右美托咪定用于预防分娩镇痛时产妇的产时发热：一项随机对照试验
硬膜外右美托咪定用于预防分娩镇痛时产妇的产时发热：一项随机对照试验
贵州医科大学 高鸿教授课题组
翻译：何幼芹 编辑：佟睿 审校：曹莹
产妇产时发热较为多发。本研究旨在探讨硬膜外右美托咪定对分娩镇痛期间产妇体温、疼痛评分及不良反应的影响。
将600例足月初产妇随机分为右美托咪定组（Dex组，n=300）和对照组（C组，n=300）。右美托咪定组给予0.1%罗哌卡因+0.5 ug/mL右美托咪定进行硬膜外镇痛，对照组给予0.1%罗哌卡因。记录分娩镇痛期间产妇的体温、视觉模拟评分（VAS）和Ramsay镇静评分（RSS），监测收缩压（SBP）、舒张压（DBP）和心率（HR）。此外，在此过程中任何不良反应也将被记录。
Dex组产时发热发生率明显低于C组（4.1% vs 8.7%，X2=5.07，P=0.024）。Dex组宫颈扩张3cm～10cm的VAS值也低于C组(1.0 ± 0.9 vs. 1.3 ± 0.7, t = 3.62, P＜0.001; 2.8 ± 0.8 vs. 3.3 ± 0.8, t = 8.09, P＜0.001; 3.1 ± 0.9 vs. 3.3 ± 0.8, t = 3.88, P＜0.001; 3.6 ± 0.8 vs. 4.1 ± 1.0, t = 5.86, P＜0.001)。Dex组宫颈扩张3cm～10cm时的HR低于C组(80.0 ± 4.3 vs. 83.1 ± 5.4 beats/min, t = 7.58, P＜0.001; 81.1 ± 4.0 vs. 83.7 ± 5.5 beats/min, t = 6.48, P＜0.001; 78.9 ± 5.4 vs. 81.5 ± 6.3 beats/min, t = 5.41, P＜0.001; 83.1 ± 5.3 vs. 84.8 ± 5.6 beats/min, t = 3.75, P＜0.001)，SBP和DBP两组相似。两组分娩镇痛期间不良事件的发生率也相似。
右美托咪定不仅可降低产时发热，还可减轻产时疼痛且不增加不良反应的发生。
Li L, Yang Z, Zhang W. Epidural Dexmedetomidine for Prevention of Intrapartum Fever During Labor Analgesia: A Randomized Controlled Trial[J]. Pain Ther, 2020, undefined: undefined.
Epidural Dexmedetomidine for Prevention of Intrapartum Fever During Labor Analgesia: A Randomized Controlled Trial
Introduction: Intrapartum fever occurs frequently during labor. The purpose of this study was to investigate the effects of epidural dexmedetomidine on maternal temperature, pain score and adverse effects during labor analgesia.
Methods: A total of 600 full-term primiparous parturients were randomly divided into two groups. The dexmedetomidine group (Group Dex, n = 300) received 0.1% ropivacaine with 0.5 ug/mL dexmedetomidine for epidural analgesia during labor, while the control group (Group C, n = 300) received 0.1% ropivacaine alone. The maternal temperature, visual analogue scale (VAS) and Ramsay sedation score(RSS) were recorded, and the systolic blood pressure (SBP), diastolic blood pressure (DBP)and heart rate (HR) were monitored. Side effects, if any, were also recorded.
Results: The incidence of intrapartum fever was lower in Group Dex than in Group C (4.1% vs. 8.7%, X2 = 5.07, P = 0.024). VAS values from the time of 3 cm cervical dilatation to 10 cm cervical dilatation were also lower in Group Dex than in Group C (1.0 ± 0.9 vs. 1.3 ± 0.7, t = 3.62, P＜0.001; 2.8 ± 0.8 vs. 3.3 ± 0.8, t = 8.09, P＜ 0.001; 3.1 ± 0.9 vs. 3.3 ± 0.8, t = 3.88, P＜0.001; 3.6 ± 0.8 vs. 4.1 ± 1.0, t = 5.86, P ＜0.001, respectively). HR from the time of 3 cm cervical dilatation to 10 cm cervical dilatation was lower during labor in Group Dex than in Group C (80.0 ± 4.3 vs. 83.1 ± 5.4 beats/min, t = 7.58, P＜0.001; 81.1 ± 4.0 vs. 83.7 ± 5.5 beats/min, t = 6.48, P ＜ 0.001; 78.9 ± 5.4 vs. 81.5 ± 6.3 beats/min, t = 5.41, P＜0.001; 83.1 ± 5.3 vs. 84.8 ± 5.6 beats/min, t = 3.75, P＜0.001, respectively), while SBP and DBP were similar between the two groups. The incidence of adverse events during labor was also similar between the two groups.
Conclusion: The present study showed that dexmedetomidine could reduce the incidence of intrapartum fever and relieve pain during labor without increasing adverse events.
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