子痫前期产妇右美托咪定胎盘转运及对新生儿安全性的影响  

作　　者：徐文平 詹淑玉[2] 张素芹 赵艳萍 夏丰[3] 

机构地区：[1]浙江省平湖市第一人民医院,314213 [2]嘉兴学院医学院,314001 [3]浙江省嘉兴市妇幼保健院,314050

出　　处：《浙江临床医学》2022年第6期884-887,共4页Zhejiang Clinical Medical Journal

基　　金：嘉兴市科技局公益性研究项目(2018AY32018)。

摘　　要：目的探讨子痫前期(PE)产妇剖宫产术中静脉使用右美托咪定(Dex)经胎盘转运情况以及对新生儿安全性的影响。方法纳入择期腰硬联合麻醉下行剖宫产的单胎孕产妇36例,其中非PE产妇(NPE组)和PE产妇(PE组)各18例,入室后给予Dex负荷量0.5μg/kg 10 min输完,维持1μg/(kg·h)直至胎儿及附属物取出。记录入室后(T_(0))以及给药后不同时间点的平均动脉压(MAP)和心率(HR),产妇药物暴露时间(T_(Dex))即Dex输注持续时间,Dex给药后至采集血标本期间心动过缓、低血压、高血压等不良事件的发生情况。测定取胎后脐动脉血气分析,母体静脉(C_(MV))、脐动脉(C_(UA))、脐静脉(C_(UV))中Dex浓度,药物胎盘转运(C_(UV)/C_(MV)),胎儿排泄率(C_(UA)/C_(UV)),新生儿体重,并在新生儿娩出后1 min、5 min进行Apgar评分。结果PE组各时间点的MAP与NPE组比较,均处于高水平(P<0.01);NPE组,与入室时(T_(0))比较,给药后T_(30)显著降低(P<0.01)。PE组,与T_(0)比较,给药后T_(20)、T_(30)均显著降低(P<0.01)。两组的心率比较,差异无统计学意义(P>0.05);NPE组,与入室时T_(0)比较,给药后T_(10)、T_(20)、T_(30)均明显下降(P<0.05);PE组,各时间点之间差异无统计学意义(P>0.05)。两组C_(MV)、C_(UA)、C_(UV)的Dex血药浓度差异无统计学意义(P>0.05)。PE组产妇Dex经胎盘转运略有升高、胎儿排泄率处于低水平,但与NPE组比较差异无统计学意义(P>0.05)。NPE组新生儿体重与PE组比较,差异有统计学意义(P<0.001)。两组的不良事件发生情况比较,差异无统计学意义(P>0.05)。结论静脉输注右美托咪定未发现对PE产妇新生儿有不良影响。Objective To investigate the transplacental transport of dexmetomidine(Dex)during cesarean section in preeclampsia(PE)and its effect on neonatal safety.Methods 36 single pregnant women with cesarean section under selective combined spinal-epidural anesthesia,including 18 non-PE women(NPE group)and 18 PE women(PE group),were given Dex loading 0.5μg/kg for 10 minutes after entering the room,and maintained at 1μg/kg until the fetus and its appendages were taken out.Mean arterial pressure(MAP)and heart rate(HR)at different time points after entry(T_(0))and administration,maternal drug exposure time(TDex),i.e.Duration of Dex infusion,and the occurrence of adverse events such as bradycardia,hypotension and hypertension between administration of Dex and blood sample collection were recorded.Umbilical artery blood gas analysis,Dex concentration in maternal vein(C_(MV)),umbilical artery(C_(UA))and umbilical vein(C_(UV)),drug placental transport(C_(UV)/C_(MV)),fetal excretion rate(C_(UA)/C_(UV)),and neonatal weight were measured after fetal extraction.Apgar score was performed at 1 min and 5 min after delivery.Results Compared with NPE group,MAP in PE group was at a high level(P<0.01).In NPE group,T_(30) decreased significantly compared with that at the time of entering the room(T_(0))(P<0.01).Compared with T_(0),T_(20) and T_(30) decreased significantly in PE group(P<0.01).There was no significant difference in heart rate between the two groups(P>0.05).In NPE group,T_(10),T_(20) and T_(30) were significantly lower than those at the T_(0) time of entering the room(P<0.05).In PE group,there was no significant difference among different time points(P>0.05).There were no significant differences in blood concentration of C_(MV),C_(UA) and C_(UV) Dex between the two groups(P>0.05).The transplacental transport of Dex was slightly increased and the fetal excretion rate was at a low level in PE group,but there was no significant difference compared with NPE group(P>0.05).There was significant difference in neonatal weight betwee

关 键 词：子痫前期 右美托咪定 胎盘转运 APGAR评分 

分 类 号：R71[医药卫生—妇产科学]