小剂量右美托咪定预防卡前列素诱发剖宫产术患者不良反应的效果  

Efficacy of small dose of dexmedetomidine for prevention of adverse effects induced by carboprost in patients undergoing caesarean section

作　　者：倪燕[1] 桂波[1] 蒋秀红[1] 丁正年[1] 

机构地区：[1]南京医科大学第一附属医院麻醉科210029

出　　处：《中华麻醉学杂志》2014年第7期830-832,共3页Chinese Journal of Anesthesiology

摘　　要：目的 评价小剂量右美托咪定预防卡前列素诱发剖宫产术患者不良反应的效果.方法 拟行子宫下段剖宫产术患者40例,ASA分级Ⅰ或Ⅱ级,年龄26 ～ 30岁,体重63 ～ 71 kg,采用随机数字表法,将其分为2组（n=20）：对照组（C组）和右美托咪定组（D组）,均在连续硬膜外麻醉下完成手术,并于胎儿娩出后,静脉输注20 U催产素,同时于子宫肌层注射卡前列素250μg.D组于卡前列素给药前1 min开始静脉输注右美托咪定（负荷量0.1 μg/kg,随后以0.4 μg·kg-1 ·h-1输注至术毕）,C组以等容量的生理盐水替代.记录卡前列素给药后相关不良反应（胸闷、面色潮红、恶心、呕吐和心血管事件）的发生情况,记录手术结束时和术后2h时警觉/镇静评分（OAA/S评分）及术后泌乳始动时间.结果 与C组比较,D组胸闷、面色潮红、恶心、呕吐、高血压、心动过速的发生率降低（P＜0.01）,2组间OAA/S评分和术后泌乳始动时间比较差异无统计学意义（P＞0.05）.结论 剖宫产术中,卡前列素给药前静脉输注小剂量右美托咪定（负荷量0.1 μg/kg,随后0.4 μg·kg-1·h-1输注至术毕）有助于预防卡前列素诱发的患者胃肠道和心血管不良反应的发生.Objective To evaluate the efficacy of small dose of dexmedetomidine for prevention of the adverse effects caused by carboprost in the patients undergoing caesarean section.Methods Forty parturients,of ASA physical status Ⅰ or Ⅱ,aged 26-30 yr,weighing 63-71 kg,scheduled for elective caesarean section under epidural anesthesia,were equally and randomly divided into control group （C group） or carboprost group （D group） by using a random number table.After delivery of the fetus,all the patients received iv infusion of 20 U oxytocin and carboprost 250 μg was injected into the myometrium simultaneously.In group D,after a loading dose of dexmedetomidine 0.1 μg/kg,dexmedetomidine was infused at a rate of 0.4 μg· kg-1 · h-1 starting from 1 min prior to carboprost injection until the end of surgery,while the equal volume of normal saline was given in group C.Adverse effects such as dyspnea,facial flushing,nausea,vomiting,hypertension and tachycardia were recorded.The OAA/S scores and time for breastfeeding initiation were also recorded at the end of surgery and 2 h after surgery.Results Compared with group C,the incidence of dyspnea,facial flushing,nausea,vomiting,hypertension and tachycardia was significantly decreased in D group.There was no significant difference in OAA/S score and the time for breastfeeding initiation after surgery between the two groups.Conclusion Small-dose dexmedetomidine （loading dose 0.1 μg/kg,followed by infusion at 0.4 μg· kg-1 · h-1 until the end of surgery） infused before carboprost administration is helpful in preventing the adverse gastrointestinal and cardiovascular reactions caused by carboprost in the patients undergoing caesarean section.

关 键 词：右美托咪啶 剖宫产术 卡波前列素 

分 类 号：R719.8[医药卫生—妇产科学]