右美托咪定联合咪达唑仑镇静在剖宫产术中的应用  

Application of Dexmedetomidine Combined with Midazolam in Cesarean Section

作　　者：黄建成 陈川钦 邓文娟 胡宏强[1] 蔡铁良[1] 沈七襄[1] HUANG Jiancheng;CHEN Chuanqin;DENG Wen juan;HU Hongqiang;CAI Tieliang;SHEN Qixiang(Department of Anesthesiology, No. 174 Hospital of Chinese People3 Liberation Army, Xiamen Fujian 361003, China)

机构地区：[1]解放军174医院麻醉科,福建厦门361003 [2]厦门大学研究生院

出　　处：《华南国防医学杂志》2018年第4期225-229,共5页Military Medical Journal of South China

基　　金：厦门市科技局计划指导性项目(3502Z20149013)

摘　　要：目的讨论右美托咪定(dexmedetomidine,Dex)联合咪达唑仑对腰麻-硬脊膜外联合麻醉下行剖宫产产妇的镇静效果。方法选取在腰麻-硬脊膜外联合麻醉下接受剖宫产术且术中麻醉效果良好的产妇120例,随机将其分为生理盐水组、咪达唑仑组、Dex组及Dex+咪达唑仑组共4组,每组30例。观察产妇在不同给药时间的平均动脉压(mean arterial pressure,MAP)、心率(heart rate,HR)、呼吸频率(respiratory rate,RR)、脉搏血氧饱和度(oxygen saturation,SpO_2)、动脉血二氧化碳分压(partial pressure of carbon dioxide,PaCO_2)、Ramsay镇静评分以及术后2h内产妇的不良反应发生情况,并统计产妇对术中镇静效果的满意度评分。结果组内比较:4组产妇在T_1时间点的MAP、HR、RR与T_0相比明显升高,差异均具有统计学意义(P<0.05);生理盐水组T_2~T_6与T1比较,MAP、HR、RR、Ramsay评分、PaCO_2、SpO_2变化差异无统计学意义(P>0.05);咪达唑仑组T_2~T_4,Dex组T_4~T_5,Dex+咪达唑仑组T_2~T_6与T1比较,MAP、HR、RR明显降低、Ramsay评分明显升高,差异具有统计学意义(P<0.05)。组间比较:4组产妇T_2~T_6时间点的MAP、HR、RR以及Ramsay评分差异都有统计学意义(P<0.05),4组产妇SpO_2、PaCO_2水平各时间点组间比较差异均无统计学意义(P>0.05);与生理盐水组相比,咪达唑仑组在T_2~T_4,Dex组T_4~T_5,Dex+咪达唑仑组T_2~T_6时间点的MAP、HR、RR明显降低、Ramsay评分明显升高,差异具有统计学意义(P<0.05),其中Dex组RR水平在T_5时间点上与生理盐水组比较差异无统计学意义(P>0.05);Dex+咪达唑仑组与咪达唑仑组相比在T_5~T_6时间点上的MAP、HR、RR明显降低、Ramsay评分明显升高,差异有统计学意义(P<0.05);Dex+咪达唑仑组与Dex组相比在T_2~T_3,T_5~T_6时间点上的HR、RR明显降低、Ramsay评分明显升高,MAP水平在T_2~T_3,T_6时间点上明显降低,差异有统计学意义(P<0.05)。Dex+咪达唑仑组不良反应发生情况、对产妇的�Objective To investigate the sedative effect of dexmedetomidine（Dex）combined with midazolam in cesarean section under combined spinal and epidural anesthesia.Methods A total of 120 puerperants who received caesarean section under combined spinal and epidural anesthesia were randomly divided into 4 groups according to random number table,including normal saline group,midazolam group,Dex group and Dex＋ midazolam group,30 cases in each group.The mean arterial pressure（MAP）and heart rate（HR）at different administration times,respiratory rate（RR）,saturation of pulse oxygen（SpO2）,partial pressure of carbon dioxide（PaCP2）,Ramsay sedation scores and postoprative 2-hour adverse reactions of puerperants were all observed,meanwhile,the satisfaction scores of the sedative effects werecalculated in puerperants.Results Intra-group comparison：compared with at T0,the MAP,RR and HR in four groups increased significantly at T1（P〈0.05）.Compared with at T1,no differences were found in MAP,RR,HR,PaCP2,SpO2 and Ramsay score among T2 ～ T6 in normal saline group（P 0.05）.Compared with that respectively between T1 and T2～T4 in midazolam group,T4～T5 in Dex group,T2～T6 and T1 in Dex＋midazolam group：MAP、RR and HR decreased and Ramsay scores increased（P〈0.05）.Comparison among groups：there were siginificantly differences in MAP,HR,RR and Ramsay score at T2～T6（P〈0.05）,SpO2 or PaCP2 at each time among four groups（P〈0.05）.Compared with normal saline group,MAP,HR and RR all decreased and Ramsay scores increased in midazolam group at T2～T4,in Dex group at T4～T5,in Dex＋midazolam group at T2～T6（P〈0.05）,but no difference was found in RR levels between Dex group and normal saline group at T5（P〈0.05）.MAP,HR,RR decreased and Ramsay scores increased between Dex＋midazolam group and midazolam group at T5～T6.HR,RR decreased and Ramsay scores increased between Dex＋midazolam group and Dex group at T2～T3 and T5～T6,except MAP levels at T6（P〈0.05）.Compared

关 键 词：右美托咪定 咪达唑仑 联合 镇静 腰麻-硬脊膜外联合麻醉 剖宫产 

分 类 号：R719.8[医药卫生—妇产科学]