静脉右美托咪啶在剖宫产术中对腰麻布比卡因阻滞效果的影响  

Effect of intravenous dexmedetomidine on bupivacaine induced subarachnoid blockade in patients undergoing cesarean section

作　　者：徐嘉莹[1] 张秀华[1] 刘俊涛[2] 黄宇光[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院麻醉科,北京100730 [2]中国医学科学院北京协和医学院北京协和医院妇产科,北京100730

出　　处：《基础医学与临床》2016年第6期826-829,共4页Basic and Clinical Medicine

摘　　要：目的观察静脉右美托咪啶在腰麻剖宫产术患者中对布比卡因阻滞时间的影响。方法将择期行剖宫产术的ASAⅠ或Ⅱ级50例产妇随机分为右美托咪啶组(DEX组)和0.9%氯化钠溶液组(NS组)。蛛网膜下腔穿刺给予0.5%布比卡因8 mg,胎儿娩出10 min后,DEX组予右美托咪啶1μg/kg,10 min输完后改为0.5μg/(kg·h)持续静注,NS组予等量0.9%氯化钠溶液静注直至术毕。记录腰麻布比卡因起效时间,感觉和运动阻滞持续时间,Ramsay镇静评分,记录胎儿娩出前(T0)、娩出后10 min(T1),试验药物给药后10 min(T2)、20 min(T3)、30 min(T4)的MAP和HR。记录药物不良反应发生率和新生儿Apgar评分。结果 DEX组的感觉和运动阻滞持续时间与NS组相比均显著延长(P<0.05)。DEX组的Ramsay镇静评分显著高于NS组(P<0.05),DEX组T2的HR明显低于NS组(P<0.05),DEX组中有6例(24%)发生心动过缓。结论在腰麻剖宫产术患者中静脉泵注右美托咪啶,可以显著延长布比卡因的感觉和运动阻滞持续时间,提供满意的镇静效果,主要不良反应为心动过缓,对血流动力学和新生儿Apgar评分无明显影响。Objective To investigate the effects of intravenous dexmedetomidine on block duration of subarachnoid bupivacaine in patients undergoing cesarean section. Methods Fifty parturients of ASAⅠorⅡscheduled for caesarean section were randomly allocated to two groups： dexmedetomidine group（ DEX group） and normal saline group（ NS group）. All parturients received 0. 5% hyperbaric bupivacaine 8 mg intrathecally. Ten mins after delivery,DEX group received dexmedetomidine 1 μg / kg bolus infusion for 10 mins followed by 0. 5 μg /（ kg·h） continuous infusion until end of surgery,whereas NS group were infused equivalent amount of volume. The onset time,sensory and motor block duration of subarachnoid bupivacaine,Ramsay score,MAP and HR of timepoint of before delivery（ T0）,10 mins after delivery（ T1）,10 mins（ T2）,20 mins（ T3） and 30 mins（ T4） after study drug infusion were recorded respectively. The incidence of drug adverse effect and Apgar score were also recorded. Results The sensory and motor block duration of DEX group were significantly prolonged compared with NS group（ P〈0. 05）. Ramsay score of DEX group was higher than that of NS group（ P〈0. 05）,and the HR of T2 of DEX group was lower than that of NS group（ P〈0. 05）. Six patients（ 24%） in DEX group experienced bradycardia. Conclusions Intravenous dexmedetomidine could significantly prolong the sensory and motor block duration of subarachnoid bupivacaine in patients undergoing cesarean section,and in the meantime provide satisfactory sedation without any obvious influence on parturient hemodynamics and neonate Apgar score. The primary adverse effect observed is bradycardia.

关 键 词：右美托咪啶 布比卡因 腰麻 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]