剖宫产患者辅用右美托咪定对新生儿的影响

Effects of dexmedetomidine as an adjuvant on newborn in parturients undergoing Cesarean section

目的探讨剖宫产患者辅用右美托咪定对新生儿的影响。方法 40例硬膜外麻醉下行剖宫产的足月初产妇随机均分为右美托咪定组(D组)和对照组(C组)。D组在硬膜外麻醉成功予负荷剂量右美托咪定0.5μg/kg,继以0.5μg·kg-1·h-1维持至术毕。C组给予等体积生理盐水。记录给药前(T0)、给药后5min(T1)、切皮时(T2)、胎儿娩出时(T3)和术毕时(T4)产妇的HR、MAP、SpO2、警觉/镇静(OAA/S)和焦虑视觉类比试验(AVAT)评分。新生儿娩出后立即取脐静脉(UV)血行血气分析,采用液相色谱串联质谱法分别测定D组新生儿UV、脐动脉(UA)和母体动脉(MA)血中右美托咪定浓度(CUV、CUA和CMA)。记录两组新生儿娩出后1-min和5-min的Apgar评分。结果与T0时比较,C组T3时MAP、HR升高(P<0.05),T1-T3时AVAT评分升高(P<0.05);与D组比较,C组T3时MAP升高(P<0.05);与C组或T0时比较,D组T2-T4时HR、OAA/S和AVAT评分降低(P<0.05)。两组新生儿血气分析值和Apgar评分差异无统计学意义(P>0.05)。CUV、CUA和CMA分别为(184.89±43.57)pg/ml、(134.96±30.75)pg/ml和(268.74±53.29)pg/ml,CUV/CMA和CUA/CUV比值分别为0.69±0.12和0.74±0.09。结论静脉输注小剂量右美托咪定0.5μg·kg-1·h-1可以减轻剖宫产产妇的焦虑和应激反应,维持血流动力学稳定,虽然易通过胎盘,但不会对新生儿产生不良影响。

Objective To investigate the effects of dexmedetomidine as an adjuvant on newborn in parturients undergoing Cesarean section.Methods Forty full-term parturients undergoing selective Cesarean section under epidural anesthesia were equally randomized into two groups of D and C.At 5 min after given epidural test dose,dexmedetomidine 0.5 μg/kg as a loading dose was given in group D,which was followed by continuous infusion of 0.5 μg·kg^-1·h^-1.Group C was infused with same volume of normal saline.HR,MAP,SpO2,and the scores of OAA/S and AVAT were recorded before administration（T0）,at 5 min after administration（T1）,skin incision（T2）,delivery of newborn（T3）and at the end of operation（T4）.The blood samples from umbilical veins（UV）,umbilical artery（UA）and maternal artery（MA）were obtained after delivery for blood gas analysis and determination of plasma dexmedetomidine concentration（CUV,CUAand CMA）using LC-MS/MS method.Apgar scores at 1 min and 5 min after delivery were recorded.Results Compared with T0,MAP,HR at T3 and AVAT score from T1 to T3 were increased in group C（P〈0.05）.Compared with group D,MAP was increased at T3 in group C（P〈0.05）.Compared with group C and T0,HR,OAA/S and AVAT scores were decreased from T2 to T4in group D（P〈0.05）.There were no significant differences in blood gas analysis and Apgar score between two groups（P〉0.05）.CUV,CUAand CMA were（184.89±43.57）pg/ml,（134.96±30.75）pg/ml and（268.74±53.29）pg/ml,respectively.The ratios of CUV to CMAand CUA to CUV were 0.69±0.12 and 0.74±0.09,respectively.Conclusion Application of dexmedetomidine 0.5 μg·kg^-1·h^-1 is able to alleviate anxiety and stress response and maintain hemodynamic stability in parturients undergoing Cesarean section.Although dexmedetomidine passes placenta easily,it has no adverse effect on newborns.