剖宫产椎管内麻醉寒战反应及右美托咪定预防研究

Postanesthetic shivering in cesarean section and research on preventive effects of dexmedetomidine

目的分析剖宫产椎管内麻醉寒战反应的影响因素及盐酸右美托咪定预防效果。方法选择2014年1月至2015年10月重庆市九龙坡区妇幼保健院剖宫产产妇1 600例根据数字列表法随机分为观察组与对照组各800例,对照组给予常规椎管内麻醉,观察组在椎管内麻醉的基础上,于胎儿娩出后立即静脉注射盐酸右关托咪定,比较两组患者剖宫产椎管内麻醉寒战反应发生率,分析两组患者寒战反应的影响因素。结果①术前基础代谢率>25.0%、术前体温>37.5℃、空腹血糖水平>7.8mmol/L、手术时间>60min、VAS疼痛评分≥5分产妇寒战反应率显著升高(x^2值分别为17.335、7.225、21.087、19.210、8.715,均P<0.05),术前无焦虑、轻度焦虑、中度焦虑、重度焦虑产妇寒战反应率依次增高,组间比较差异有统计学意义(x^2=26.324,P<0.05);②术前基础代谢率、空腹血糖水平、术前焦虑、手术时间是影响剖宫产椎管内麻醉寒战反应的关键因素(OR值分别为4.391、5.535、3.612、4.307,均<0.05);③观察纽产妇椎管内麻醉后寒战发生率为12.38%,显著低于对照组的41.50%,比较差异有统计学意义(x^2=38.152,P<0.05)。结论高基础代谢率、高血糖、术前焦虑及手术过长是导致剖宫产椎管内麻醉寒战反应的主要影响因素,给予盐酸右美托咪定可有效预防其发生。

Objective To analyze the influencing factors for postanesthetic shivering （PAS） in cesarean section and the preventive effects of dexmedetomidine. Methods According to random number table, 1 600 cases of puerperas undergoing cesarean section and selected from Maternal and Child Health Care hospital of Jiulongpo District in Chongqing from January 2014 to October 2015 were randomly divided into observation group and control group （ n = 800）. Patients in the control group underwent regular spinal anesthesia. On the basis of spinal anesthesia, puerperas in the observation group received intravenous injection of dexmedetomidine hydrochloride right after delivering. Incidence of PAS in cesarean section was compared between two groups. Besides, influencing factors for PAS were analyzed. Results The incidence rate of PAS in patients whose preoperative basal metabolic rate 〉 25.0%, preoperative temperature 〉 37.5℃, fasting plasma glucose level 〉 7.8mmol/L, operation duration 〉 60 min, VAS pain score ≥ 5 points increased significantly （χ^2 = value was 17. 335, 7. 225, 21. 087, 19. 210 and 8. 715, respectively, all P 〈0.05）. The incidence rate of PAS increased in turn in puerperas without anxiety, with mild anxiety, with moderate anxiety and with severe anxiety before surgery. The differences were statistically significant （χ^2 = 26. 324, P 〈 0.05 ）. Preoperative basal metabolic rate, fasting blood glucose level, preoperative anxiety, operation duration were the key factors for PAS in cesarean section （ OR value was 4. 391, 5. 535, 3. 612 and 4. 307, respectively, all P 〈 0.05）. The incidence rate of PAS in the observation group was 12.38%, which was significantly lower than 41.50% in the control group with significant difference （χ^2= 38. 152, P 〈 0. 05 ）. Conclusion High basal metabolic rate, high blood sugar, preoperative anxiety and long operation duration are main influencing factors for PAS in cesarean section. Dexmedetomidine hydrochloride can effectively prevent the occurrence of shivering.