摘要目的 探讨右美托咪定复合罗哌卡因腰方肌阻滞对剖宫产产妇实施的效果及术后镇痛作用。方法 选取2019年4月至2021年7月沭阳医院收治的66 例择期行单次腰麻剖宫产术的初产妇为研究对象，采用随机数字表法将其分成两组，每组各33 例。对照组术后实施罗哌卡因腰方肌阻滞，观察组则在对照组的基础上复合右美托咪定，同时两组术后采用自控静脉镇痛。比较两组术后的静息疼痛评分、运动疼痛评分、术后48 h 舒芬太尼使用量、术后48 h 镇痛泵按压次数及不良反应总发生率。结果 观察组产妇术后24、36、48 h 的静息、运动视觉模拟评分法（VAS）评分低于对照组，差异有统计学意义（P＜0.05）；两组的不良反应总发生率比较，差异无统计学意义（P＞0.05）；而观察组产妇术后48 h 的舒芬太尼使用量及镇痛泵按压次数均少于对照组，差异有统计学意义（P＜0.05）。结论 在剖宫产产妇的术后镇痛中，实施腰方肌右美托咪定联合罗哌卡因阻滞能为产妇提供更完善且长时间的镇痛作用，且用药后不良反应总发生率不高，安全性良好，在剖宫产术后镇痛中不失为一种较理想的镇痛方案，值得参考借鉴。
Abstract：Objective To evaluate the effect of Dexmedetomidine combined with Ropivacaine quadratus lumborum block on cesarean section puerpera and postoperative analgesia.Methods A total of 66 primipara who were treated in Shuyang Hospital from April 2019 to July 2021 and underwent elective single-session spinal anesthesia and cesarean section were selected as the research objects,and they were divided into two groups by random number table method,with 33 cases in each group.The control group was given Ropivacaine quadratus lumborum block after operation,the observation group was combined with Dexmedetomidine on the basic of the control group,and the two groups were given patient-controlled intravenous analgesia after operation.The resting pain score,exercise pain score,Sufentanil consumption at 48 h after surgery,the number of analgesic pump pressings at 48 h after surgery and the total incidence of adverse reactions were compared between the two groups.Results The visual analogue scale (VAS) score of rest and motion pain in the observation group were lower than those in the control group at 24,36 and 48 hours after operation,and the differences were statistically significant (P＜0.05).There was no significant difference in the total incidence rate between the two groups (P＞0.05).The dosage of Sufentanil and the times of analgesic pump pressings in the observation group at 48 h after operation were less than those in the control group,and the differences were statistically significant(P＜0.05).Conclusion In the postoperative analgesia of puerpera with cesarean section,the implementation of right Medetomidine combined with Ropivacaine block of psoas quadratus muscle can provide more perfect and long-term analgesia for puerpera,and the incidence of adverse reactions after medication is not high,with good safety.It is an ideal analgesic scheme in the postoperative analgesia of cesarean section,which is worthy of reference.
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