探讨剖宫产术时腰硬联合麻醉中患者寒战的临床预防

Clinical prevention of intraoperative chills for patients undergoing cesarean section with epidural anesthesia

目的探析应用小剂量硫酸镁和曲马多预防腰硬联合麻醉剖宫产患者术中寒战的临床效果。方法选择2013年1月至6月在萧山医院实施腰硬联合麻醉剖宫产术患者90例作为观察对象,按预防寒战给药的不同分为A、B、C组,每组各30例。A组术前给予静注生理盐水5mL,B组予以10mg/kg硫酸镁,C组给予1.0～1.5mg/kg曲马多,比较3组患者围术期寒战情况、各组产妇血氧饱和度(SPO_2)、嗜睡、恶心呕吐,新生儿Apgar评分情况。结果 B、C组的寒战程度及发生率显著低于A组,差异均有统计学意义(x～2值分别为8.53、10.33,均P<0.01);C组发生呕吐恶心情况显著高于A、B两组,差异均有统计学意义(x～2值分别为6.41、4.32,均P<0.05);3组新生儿1min、5min的Apgar评分比较差异均无统计学意义(均P>0.05)。结论腰硬联合麻醉剖宫产患者术中寒战应用曲马多和小剂量硫酸镁进行预防,临床效果确切,但曲马多会导致产妇呕吐恶心。

Objective To explore the clinical effect of small doses of magnesium sulfate and tramadol in preventing intraoperative chills of patients undergoing cesarean section with lumbar epidural anesthesia .Methods From January to June of 2013 90 cases undergoing cesarean section with lumbar epidural anesthesia in Xiaoshan Hospital of Zhejiang Province were selected in the study , and they were divided into three equal groups （ group A, group B and group C ） according to different therapy .Group A was given intravenous saline 5mL before operation, group B was given 10mg/kg magnesium sulfate, and group C was given 1.0-1.5mg/kg tramadol.Three groups were compared in terms of intraoperative chills, maternal SPO2, drowsiness, nausea, vomiting and Apgar score.Results The chills degree and the incidence of chills of group B and group C were significantly lower than group A （χ^2 value was 8.53 and 10.33, respectively, both P〈0.01）.The incidence of nausea and vomiting in group C was significantly higher than group A and group B （χ^2 value was 6.41 and 4.32, respectively, both P〈0.05）.There was no significant difference in neonatal Apgar 1min and 5min score among three groups （ all P〉0.05）.Conclusion Small dose of tramadol and magnesium sulfate in preventing intraoperative chills of patients undergoing cesarean section with lumbar epidural anesthesia has accurate clinical effect , but it will induce maternal nausea and vomiting .