曲马多、酒石酸布托啡诺与盐酸右美托咪定治疗腰硬联合麻醉剖宫产患者寒战的效果比较

Efficacy of tramadol,butorphanol and dexmedetomidine on shivering in caesarean section after combined-spinal epidural anesthesia

目的观察比较静注曲马多、布托啡诺、右美托咪定对剖宫产腰硬联合麻醉后寒战的治疗效果。方法选择ASAⅡ～Ⅲ级剖宫产腰硬联合麻醉后寒战的子痫前期患者180例,随机分为曲马多、布托啡诺、右美托咪定3组,每组60例。对于发生寒战的患者,待胎儿取出后,分别静注曲马多1.0 mg/kg、布托啡诺0.01 mg/kg或右美托咪定0.5μg/kg,观察寒战改善情况、用药后镇静程度及不良反应发生情况。结果三组治疗寒战的有效率差异无统计学意义（P〉0.05）。给药后,曲马多组有9例发生恶心,4例发生呕吐;布托啡诺组有5例发生恶心,无呕吐发生。右美托咪定组有1例发生恶心,无呕吐发生。三组均无呼吸抑制。与曲马多组相比,布托啡诺组、右美托咪定组不良反应发生率均较低（P〈0.05）。结论三种药物均可以有效治疗寒战,右美托咪定镇静效果更佳,且不良反应更少。

Objective To observe the clinical efficacy of tramadol,butorphanol and dexmedetomidine on shivering in caesarean section after combined-spinal epidural anesthesia（ CSEA）. Methods 180 parturient women（ ASAⅡ ～ Ⅲ） with preeclampsia were randomly divided into three groups（ n = 60） all the patients chose caesarean section after combined-spinal epidural anesthesia. After the fetus was token out,patients with shivering during anesthesia in the 3 groups were treated with tramadol 1. 0 mg / kg,butorphanol 0. 01 mg / kg and dexmedetomidine 0. 5 μg / kg respectively. The therapeutic effects,adverse effects and Ramsay scores were observed. Results There was no significant difference among these groups in treating shivering（P〈0. 05）. There was 9 nausea cases and 4 vomiting cases in tramadol group and 5 nausea cases in butorphanol group,while 1 nausea case in dexmedetomidine group. Compared with tramadol group,the incidences of adverse effects of nutorphanol group and dexmedetomidine group were low er（P〈0. 05）.Conclusion Tramadol,butorphanol and dexmedetomidine can be used to treat shivering during combined-spinal epidural anesthesia,and dexmedetomidine is better at Ramsay score with fewer adverse effects.