右美托咪定靶控输注对子痫前期患者剖宫产术中产妇循环状况及新生儿安全性的影响  

Effect of target-controlled infusion of dexmedetomidine on maternal circulation and neonatal safety during cesarean section in patients with preeclampsia

作　　者：张素芹 赵艳萍 夏丰[1] 徐文平[1] ZHANG Su-Qin;ZHAO Yan-Ping;XIA Feng(Department of Anesthesiology,Jiaxing Municipal Maternal and Child Health Care Hospital,Jiaxing,Zhejiang 314001,China)

机构地区：[1]嘉兴市妇幼保健院麻醉科,浙江嘉兴314001

出　　处：《中国妇幼保健》2021年第20期4664-4669,共6页Maternal and Child Health Care of China

基　　金：浙江省嘉兴市科技局公益性研究项目(2018AY32018)。

摘　　要：目的探讨分析右美托咪定(Dex)靶控输注对子痫前期患者剖宫产术中产妇循环状况影响,并对其新生儿安全性进行评价。方法选取嘉兴市妇幼保健院在2017年1月-2020年6月收治的120例椎管内麻醉下行剖宫产术的子痫前期孕产妇作为研究对象,利用随机数表法将孕产妇分为4组各30例,于麻醉穿刺工作完成后进行镇静输注。观察1组采用0.4 ng/ml靶浓度进行输注,观察2组采用0.6 ng/ml进行输注,观察3组采用0.8 ng/ml进行输注,对照组则采用生理盐水进行输注。所有患者均连续监测给药前(T0)、给药后10 min(T1)、30 min(T2)和取胎时(T3)的心排血指数(CI)、平均动脉压(MAP)、脉搏(HR)和Ramsay镇静评分;同时对所有新生儿进行1 min、5 min Apgar评分,所有孕产妇均行脐动脉血气分析,并记录产妇产后48 h内的不良反应发生情况。结果所有患者在进入手术后CI均显著下降,在T2时段与T3时段,观察2组患者的CI显著低于观察1组和对照组患者,而观察3组患者的CI显著低于观察1组、2组和对照组患者,差异均有统计学意义(P<0.05)。所有患者在给药10 min后MAP均显著下降,在T2时段,观察2组患者的MAP显著低于观察1组和对照组患者,而观察3组患者的MAP显著低于观察1组、2组和对照组患者,差异均有统计学意义(P<0.05)。观察组患者在给药后HR均显著下降,在T1时段和T2时段,观察3组患者的HR均显著低于观察1组和对照组患者,差异均有统计学意义(P<0.05)。观察组患者在给药后Ramsay评分均显著上升,在T1、T2、T3时段,观察2组患者的Ramsay评分显著高于观察1组和对照组患者,而观察3组患者的Ramsay评分显著高于观察1组、2组和对照组患者,差异均有统计学意义(P<0.05)。观察组各组患者在新生儿Apgar评分指标上差异无统计学意义(P>0.05)。观察1、2、3组患者的血气分析情况和乳酸值均在正常值范围内,且各组间差异无统计学意义(P>0.05)。�Objective To explore and analyze the effect of target-controlled infusion of dexmedetomidine on maternal circulation during cesarean section in patients with preeclampsia, evaluate neonatal safety. Methods A total of 120 preeclampsia women undergoing cesarean section under intraspinal anesthesia were selected as research object in Jiaxing Municipal Maternal and Child Health Care Hospital from January 2017 to June 2020. Using random number table method, the pregnant women were divided into 4 groups, 30 cases in each group, and sedation infusion was performed after finish of anesthesia puncture work. Observation group 1 was infused with a target concentration of 0.4 ng/ml, observation group 2 was infused with a target concentration of 0.6 ng/ml, observation group 3 was infused with a target concentration of 0.8 ng/ml, and control group was infused with normal saline. All patients were continuously monitored for cardiac output index(CI), mean arterial pressure(MAP), pulse(HR), and Ramsay sedation score before administration(T0), 10 minutes after administration(T1), 30 minutes after administration(T2), and at the time of fetal removal(T3);one-minute Apgar score and five-minute Apgar score were performed among all the neonates, umbilical artery blood gas analysis was performed among all the pregnant women, and the adverse reactions within 48 hours after delivery were recorded.Results CI of all patients decreased significantly after starting the operation, during T2 and T3 periods, CI in observation group 2 was significantly lower than those in observation group 1 and control group, while CI in observation group 3 group was significantly lower than those in the other three groups, the differences were statistically significant(P<0.05).MAP of all patients decreased significantly after 10 minutes of administration. During T2 period, MAP in observation group 2 was significantly lower than those in observation group 1 and control group, while MAP in observation group 3 was significantly lower than those in the other three

关 键 词：右美托咪定 靶控输注 子痫前期 孕产妇 剖宫产术 新生儿 

分 类 号：R714.244[医药卫生—妇产科学]