右美托咪定静脉输注与硬膜外注射对再次剖宫产术麻醉效果及新生儿的影响  

Effects of Dexmedetomidine by Intravenous Infusion and Epidural Injection on Effectiveness of Anesthesia in Patients with Repeat Cesarean Section and Newborns

作　　者：刘智娜[1] 白延平[2] 胡彬[1] LIU Zhi-na1, BAI Yan-ping2 , HU Bin1(1. Department of Anesthesiology, 2. Department of Cardiology, Affiliated Hos- pital of Yan＇an University, Yan＇an, Shaanxi 716000, China)

机构地区：[1]延安大学附属医院麻醉科,陕西延安716000 [2]延安大学附属医院心内科,陕西延安716000

出　　处：《解放军医药杂志》2018年第10期101-105,共5页Medical & Pharmaceutical Journal of Chinese People’s Liberation Army

基　　金：陕西省卫生厅科研基金项目(2014JM49656)

摘　　要：目的分析右美托咪定静脉输注与硬膜外注射对再次剖宫产术硬膜外麻醉效果的影响。方法选取2015年9月—2017年3月收治的再次剖宫产术产妇108例。根据麻醉方式分为A、B和C组,每组36例。A组给予右美托咪定静脉输注联合罗哌卡因硬膜外注射,B组给予罗哌卡因联合右美托咪定硬膜外注射,C组给予罗哌卡因硬膜外注射。比较3组手术不同时间的心率、平均动脉压(MAP),记录和评估3组麻醉效果及不良反应发生情况,评估对新生儿的影响。结果硬膜外注药完毕后10 min和30 min以及手术结束即刻,C组心率和MAP水平均高于麻醉前即刻,A组和B组低于C组(P <0. 05)。与A组和C组比较,B组的麻醉起效时间和达峰效应时间明显缩短,麻醉平面持续时间明显延长(P <0. 05)。3组新生儿出生后1 min和5 min的Apger评分比较差异无统计学意义(P>0. 05)。A组和B组的Ramsay镇静评分高于C组,术中牵拉反应程度以及寒战发生率明显低于C组(P <0. 05)。结论右美托咪定静脉给药和硬膜外给药都能较好地辅助再次剖宫产硬膜外麻醉的效果,且对新生儿无明显影响,同时硬膜外给予右美托咪定联合罗哌卡因可明显缩短起效时间,延长麻醉持续时间。Objective To analyze effects of Dexmedetomidine by intravenous infusion and epidural injection on effectiveness of anesthesia in patients with repeat cesarean section and newborns. Methods A total of 108 lying in women with cesarean section during September 2015 and March 2017 were divided into group A, B and C （ n = 36 for each group） according to anesthesia methods. Group A was given Dexmedetomidine by intravenous infusion combined with Ropivacaine by epidural injection, and group B was given Ropivacaine combined with Dexmedetomidine by epidural injection, while group C was given Ropivacaine by epidural injection. Among 3 groups, values of heart rate （HR） and mean arterial pressure （MAP） at different times were compared, and conditions of HR during anaesthesia and incidence of adverse reactions were recorded and evaluated, and effects on newborns were also evaluated. Results At 10 min and 30 min after epidural injection and at the time of operation ending, HR and MAP levels were significantly higher than those before anesthesia immediately in group C, and HR levels in group A and group B were significantly lower than those in group C （P 〈 0.05）. Compared with those in group A and C, the onset time and peak effect time of anesthesia were significantly shortened, while duration of anesthesia plane was significantly prolonged in group B （P 〈 0.05）. There were no significant differences in Apger scores at 1 rain and 5 rain after neonates among 3 groups （P 〉 0.05）. In group A and B, Ramsay sedation scores were significantly higher, while degree of traction reaction and incidence rate of shivering dur- ing operation were significantly lower than those in group C （P 〈 0.05）. Conclusion Both Dexmedetomidine by intra- venous and epidural administration may effectively assist epidural anesthesia of secondary cesarean section without signifi- cant effect on newborns. While Dexmedetomidine combined with Ropivacaine by epidural anesthesia may significantly shorten onset time and prolong a

关 键 词：剖宫产术 再 右美托咪定 输注 静脉内 注射 硬膜外 麻醉硬膜外 

分 类 号：R614[医药卫生—麻醉学]