不同剂量右美托咪定对剖宫产术后镇痛效果的观察  

Observation about Different Doses of Dexmedetomidine on the Postoperative Analgesic Effect during Cesarean Section

作　　者：雷秋林[1] 吴毅欢 龚赞辉 

机构地区：[1]福建省立医院麻醉科,福州350001

出　　处：《海峡药学》2017年第6期71-73,共3页Strait Pharmaceutical Journal

摘　　要：目的观察不同剂量右美托咪定对剖宫产术后的镇痛效果。方法择期腰-硬联合麻醉下行剖宫产术初产妇120例,随机分为4组(n=30):对照组(C组),右美托咪定0.5、0.75和1μg·kg^(-1)组(D1组、D2组和D3组)。胎儿娩出断脐后,D1组、D2组和D3组分别静脉泵注右美托咪定0.5、0.75和1μg·kg^(-1)10min后,改0.4μg/(kg·h)静脉泵注20min;C组静脉泵注30m L 0.9%Na Cl。记录术中血流动力学变化,术后1h(T1)、2h(T2)、4h(T3)、8h(T4)和24h(T5)VAS评分,首次PCIA按压时间,累积PCIA按压次数及有效按压次数,不良反应:头晕,寒战,恶心、呕吐。结果与C组比较,D1组、D2组术中心动过缓、低血压发生率无统计学差异(P>0.05),D3组发生率明显增高(P<0.05)。与C组比较,D1组、D2组和D3组术后VAS评分降低,术后首次PCIA按压时间延长,累积PCIA按压次数及有效按压次数减少(P<0.05);与D1组比较,D2组和D3组指标变化更显著(P<0.05),但D2组和D3组指标比较无统计学差异(P>0.05)。与C组比较,D1组和D2组术后头晕、寒战、恶心、呕吐发生率降低,而D3组术后头晕发生率增高,有统计学差异(P<0.05)。结论术中静脉输注Dex 0.75μg·kg^(-1)10min后,改0.4μg/(kg·h)静脉泵注20min,血流动力学稳定,术后镇痛效果佳,不良反应发生少。OBJECTIVE To observe the effect of Dex on the postoperative analgesia during cesarean sec- tion. METHODS 120 cases of spinal-epidural anesthesia undergoing elective cesarean section were randomly divid- ed into four groups （n =30） ：Dex 0. 5μg· kg-1 group （group D1 ） ,Dex 0. 75μg · kg-1 group （group D2） ,Dex 1μg·kg-1 group （ group D3 ） and control group （ group C）. As soon as fetus was removed, 0. 5 μg·kg- 1,0. 75 μg·kg-1 and 1.01μg ·kg-1 Dex were infused in group D1, D2 and D3 over 10min respectively, then 0. 4μg/（ kg · h） Dex infused for 20min. Group C was pumped into 30mL 0. 9% NaC1. Hemodynamic changes, visual analogue scale （VAS） score in 1 h（T1） ,2 h（T2） ,4 h（T3） ,8 h（T4） and 24 h（T5） after surgery,time of first rescue analgesia, cumulated pressing numbers and effective pressing numbers in 24h were recorded. The latter included the side effects such as dizzy, shivering,nausea and vomiting. RESULTS Compared to group C,there was no significant difference in the incidence of bradycardia and hypotension between group D1 and group D2 （P 〉 0. 05 ）, which was increased significantly in group D3 （ P 〈 0. 05 ）. Compared with group C, the VAS scores after surgery were lower, the time of first rescue analgesia was longer, and cumulated pressing numbers and effective pressing numbers were decreased in group D1 ,D2 and D3 （P 〈0. 05）. The changes of which in group D2 and D3 were more obvious （P 〈0.05） com- pared with group D1. However,no significant difference was observed in group D2 and D3 （P 〉 0. 05 ）. Compared with group C, the incidence of postoperative dizzy, shivering, nausea and vomiting in 24 h was reduced in group D1 and D2, but the incidence of postoperative dizzy was increased in group D3 （P 〈 0. 05 ） CONCLUSION Intraoper- ative infusion of 0. 75μg· kg- 1 Dex over 10min, then infusing 0. 41xg/（ kg· h） Dex for 20rain has stable emodynam- ic, good postoperative analgesic effect and less adverse reactions.

关 键 词：右美托咪定 腰-硬联合麻醉 剖宫产 术后镇痛 

分 类 号：R969.4[医药卫生—药理学]