科學也可以如此靠近

靜脈注射地塞米松可作為改善分娩鎮痛的輔助用藥

2月
03
2019

2019年2月03日19時 麻醉MedicalGroup

麻醉MedicalGroup

背景與目的

研究靜脈注射(i.v.)地塞米松作為輔助分娩鎮痛中的作用。

方 法

三級教學醫院的,八十位ASA I-II級、年齡> 18歲、未產婦、單胎妊娠、頭顱表現≥36周的孕產婦,且在自發性分娩的早期(宮頸擴張≤5cm)要求硬膜外鎮痛。將患者隨機分為兩組。地塞米松組在手術前約45分鐘時將8mg地塞米松溶在50ml生理鹽水中從靜脈給。安慰劑組患者僅靜脈給予50ml生理鹽水。所有患者均按醫院方案實施硬膜外鎮痛。在初次推注藥物後,連續給予5ml/

h的0.1%左旋布比卡因和2μg/ ml芬太尼,如果需要,可給予患者維持所用的相同藥物組合5ml,間隔時間12min。
主要結局指標:神經軸突所給的左布比卡因芬太尼組合的小時平均消耗量。次要結局和觀察指標:疼痛評分,產婦滿意度,感覺和運動阻滯情況,產婦的血液動力學指標,胎兒心率,第二產程持續時間,分娩方式,Apgar評分在1-5分,以及不良反應。

結 果

與安慰劑組相比,地塞米松組小時平均藥物消耗量顯著降低(10.34±1.79ml / h VS 11.34±1.83ml / h;平均差異為1.007,95%CI為 0.199-1.815; P = 0.015)。Dexa和安慰劑組的推注中位數分別為4(四分位數範圍 3-5.75)和5(IQR 3-6)(P =

0.162)。關於疼痛評分,產婦滿意度和血液動力學指標,分娩方式和不良反應,組間無顯著差異性。

結 論

靜脈注射地塞米松顯著降低通過硬膜外途徑給左布比卡因 - 芬太尼組合的小時平均藥物消耗量,此方法可減少分娩鎮痛期間的硬膜外藥物用量。

原始文獻摘要

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 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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