硬膜外注射右美托咪定预防剖宫产术中卡前列素氨丁三醇不良反应  

Epidural Administration of Dexmedetomidine for Preventing Carboprost Tromethamine Adverse Effects in Cesarean Section

作　　者：李君晴 李文谦 LI Junqing;Li Wenqian(Department of Anesthesiology,the Affiliated Hospital of Guizhou Medical University,Guiyang Guizhou 550004,China)

机构地区：[1]贵州医科大学附属医院麻醉科,贵州贵阳550004

出　　处：《中国卫生标准管理》2023年第6期117-121,共5页China Health Standard Management

摘　　要：目的评价在硬膜外注射右美托咪定在预防剖宫产术中卡前列素氨丁三醇引起不良反应的疗效。方法选择2022年5—8月在贵州医科大学附属医院拟硬膜外麻醉下行择期剖宫产术的孕妇40例,ASA分级Ⅰ或Ⅱ级,年龄22~40岁,体质量51~82 kg,随机分为罗哌卡因混合右美托咪定组(D组)与罗哌卡因混合生理盐水组(C组),每组20例。硬膜外穿刺成功并排除脊麻征象后,D组在硬膜外腔注射0.75%罗哌卡因13 mL混合含1µg/kg的右美托咪定2 mL,C组硬膜外腔注射0.75%罗哌卡因13 mL混合0.9%生理盐水2 mL。记录硬膜外阻滞起效时间、最高平面及感觉阻滞时间。观察子宫体注射卡前列素氨丁三醇后产妇恶心、呕吐、胸痛、腹痛、头晕、面部潮红等不良反应发生情况。记录使用卡前列素氨丁三醇时和30 min后的Ramsay镇静评分(the ramsay sedation scale,RSS)、使用卡前列素氨丁三醇至手术结束心血管事件发生情况、新生儿1、5 min时Apgar评分、术后麻醉相关并发症发生情况。结果D组与C组比较,硬膜外麻醉起效时间缩短、感觉阻滞时间延长(P<0.05),最高阻滞平面差异无统计学意义(P>0.05);卡前列素氨丁三醇相关不良反应发生率降低,Ramsay镇静评分升高,心血管事件发生率降低(P<0.05);新生儿Apgar评分及术后麻醉相关并发症发生情况差异无统计学意义(P>0.05)。结论硬膜外注射右美托咪定可安全有效地用于防治剖宫产术中卡前列素氨丁三醇引起的不良反应。Objective To evaluate epidural administration of dexmedetomidine in preventing the adverse effects of carboprost tromethamine in the patients undergoing cesarean section.Methods From May to August 2022 in the Affiliated Hospital of Guizhou Medical University,a total of 40 patients with ASA physical status I orⅡ,aged 22-40 years,weighing 51-82 kg,scheduled for elective cesarean section under epidural anesthesia,were randomly divided into 2 groups:mixture of ropivacaine and dexmedetomidine group(group D)and mixture of ropivacaine and normal saline group(group C)(n=20 each).After identification of the epidural space and exclusion of spinal analgesia,a mixture of 0.75%ropivacaine 13 mL and dexmedetomidine 1μg/kg was injected epidurally in group D,a mixture of 0.75%ropivacaine 13 mL and normal saline 2 mL was injected epidurally in group C.Recording the onset time of sensory block,maximum level of sensory block,and duration of sensory block.Recording adverse reactions after carboprost tromethamine was injected into the body of the uterus,such as nausea,vomiting,chest pain,dizziness and facial flushing.Recording ramsay sedation score when injecting carboprost tromethamine and 30 min later,the occurrence of cardiovascular events from the end of carboprost tromethamine administration until the end of surgery,neonatal Apgar scores at 1 and 5 min,and the occurrence of complications associated with anesthesia during the postoperative follow-up.Results Compared with group C,the onset time of epidural anesthesia was shortened and the sensory block time was prolonged in group D(P<0.05),and there was no significant difference in the highest block plane(P>0.05).The incidence of adverse reactions related to carboprost tromethamine decreased,Ramsay sedation score increased and the incidence of cardiovascular events decreased(P<0.05).There was no significant difference in Apgar score of newborns and incidence of postoperative anesthesia-related complications(P>0.05).Conclusion Epidural administration of dexmedetomidine can reduc

关 键 词：右美托咪啶 麻醉 硬膜外 卡波前列素 剖宫产术 不良反应 

分 类 号：R453[医药卫生—治疗学]