静脉注射地塞米松作为改善分娩镇痛的辅助：随机、双盲、安慰剂对照试验
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Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized, double-blinded, placebo controlled clinical trial
背景与目的
研究静脉注射（i.v.）地塞米松作为辅助分娩镇痛中的作用。
方 法
三级教学医院的，八十位ASA I-II级、年龄> 18岁、未产妇、单胎妊娠、头颅表现≥36周的孕产妇，且在自发性分娩的早期（宫颈扩张≤5cm）要求硬膜外镇痛。将患者随机分为两组。地塞米松组在手术前约45分钟时将8mg地塞米松溶在50ml生理盐水中从静脉给。安慰剂组患者仅静脉给予50ml生理盐水。所有患者均按医院方案实施硬膜外镇痛。在初次推注药物后，连续给予5ml/ h的0.1％左旋布比卡因和2μg/ ml芬太尼，如果需要，可给予患者维持所用的相同药物组合5ml，间隔时间12min。 主要结局指标：神经轴突所给的左布比卡因芬太尼组合的小时平均消耗量。次要结局和观察指标：疼痛评分，产妇满意度，感觉和运动阻滞情况，产妇的血液动力学指标，胎儿心率，第二产程持续时间，分娩方式，Apgar评分在1-5分，以及不良反应。
结 果
与安慰剂组相比，地塞米松组小时平均药物消耗量显着降低（10.34±1.79ml / h VS 11.34±1.83ml / h;平均差异为1.007,95％CI为 0.199-1.815; P = 0.015）。Dexa和安慰剂组的推注中位数分别为4（四分位数范围[IQR] 3-5.75）和5（IQR 3-6）（P = 0.162）。关于疼痛评分，产妇满意度和血液动力学指标，分娩方式和不良反应，组间无显着差异性。
结 论
静脉注射地塞米松显着降低通过硬膜外途径给左布比卡因 - 芬太尼组合的小时平均药物消耗量，显示此方法可减少分娩镇痛期间的硬膜外药物用量。
原始文献摘要
Dube P, Mitra S, Singh J,et al.Intravenous dexamethasone as an adjunct to improve labor analgesia: A randomized,double-blinded, placebo controlled clinical trial.J Clin Anesth. Sep 2017 ;43:6-10.doi: 10.1016/j.jclinane.2017.09.003.
OBJECTIVE:To study the role of intravenous (i.v.) dexamethasone as an analgesic adjunct in labor analgesia.
DESIGN:Double-blinded randomized controlled trial.
SETTING:Labor analgesia in a tertiary-care teaching hospital.
PATIENTS:Eighty consenting ASA I-II parturients, age>18year, nulliparous, single gestation, cephalic presentation at ≥36 wk. of gestation, in early spontaneous labor (cervical dilatation≤5cm) requesting epidural analgesia.
INTERVENTIONS:The patients were randomized to two groups. The Dexa group received 8mg of dexamethasone i.v. in 50ml normal saline approximately 45min before the procedure. Placebo group patients received 50ml normal saline only. All patients underwent epidural labor analgesia per hospital protocol. After an initial bolus, they received continuous background infusion of 5ml/h of 0.1% of levobupivacaine with 2μg/ml of fentanyl, with the provision of patient controlled boluses of 5ml of the same drug combination with a lockout interval of 12min if needed.
MEASUREMENTS:Primary outcome measure: hourly average consumption of neuraxially administered levobupivacaine-fentanyl combination. Secondary outcomes and observations: pain score, maternal satisfaction, sensory and motor block characteristics, hemodynamic parameters of mother, fetal heart rate, duration of second stage of labor, mode of delivery, Apgar scores at 1 and 5min, and adverse effects.
MAIN RESULTS:Average hourly drug consumption was significantly lower in Dexa group as compared to Placebo group (10.34±1.79ml/h vs. 11.34±1.83ml/h; mean difference 1.007, 95% CI 0.199-1.815; P=0.015). The median number of bolus doses was 4 (interquartile-range [IQR] 3-5.75) and 5 (IQR 3-6) in the Dexa and Placebo groups, respectively (P=0.162). There was no significant difference between groups with regard to pain scores, maternal satisfaction and hemodynamics, mode of delivery, and adverse effects.
CONCLUSIONS:I.v. dexamethasone significantly decreased hourly average drug consumption of levobupivacaine-fentanyl combination through the epidural route, demonstrating the epidural drug dose sparing effect during labor analgesia.
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