地佐辛与曲马朵在预防剖宫产术中寒战的效果比较

Comparison of the effects of dezocine and tramadol for the prevention of shivering in cesarean section

目的：观察地佐辛、曲马朵用于预防剖宫产产妇寒战反应的安全性和有效性。方法将240例行剖宫产手术产妇（均为腰硬联合麻醉，ASAⅠ～Ⅱ）按照数字表法随机分为三组，每组80例。腰硬联合阻滞完成产妇平卧后A组即予预防性静脉注射地佐辛0．1 mg／kg，B组予预防性静脉注射曲马朵1 mg／kg，C组（对照组）注射0．9％氯化钠注射液20 mL，持续监测围术期呼吸、循环的变化，观察记录产妇寒战、不良反应及新生儿Apgar评分。结果 A组、B组麻醉后寒战发生率分别为5．0％、7．5％，而C组发生率为60．0％， A组、B组显著降低（H＝3．418，P＝0．019）；但B组产妇恶心、呕吐发生率为45．0％，较A组（10．0％）和C组（7．5％）显著增高（χ^2＝11．491，P＝0．021）。三组新生儿 Apgar评分差异无统计学意义（F＝10．062，P＝0.017）。结论曲马朵与地佐辛均能有效预防剖宫产术中寒战，且对新生儿Apgar评分无影响，但曲马朵的恶心、呕吐发生率显著高于地佐辛。

Objective To observe the effect and safety of dezocine and tramadol for the prevention of shive-ring in cesarean section.Methods According to the digital table,240 routine cesarean mothers （both epidural anesthesia,ASA Ⅰ-Ⅱ）were randomly divided into three groups,each group in 80 cases.After the completion of combined spinal epidural,group A received verdict preventive maternal supine dezocine intravenous 0.1 mg/kg（dilu-ted to 20mL with saline）,group B for prophylactic intravenous tramadol 1 mg/kg（with saline diluted to 20mL）,group C（control group）received normal saline 20mL,continuous monitoring of perioperative respiratory,circulation chan-ges,maternal chills,adverse reactions and Apgar score were observed and recorded.Results The incidence of post-anesthetic shivering maternal of group A and group B were 5.0%,7.5% respectively,while the rate was 60% in group C,there was significant difference between group A and group B（H=3.418,P=0.019）;,but the maternal nausea and vomiting incidence of group B（45.0%）was significantly higher than those of group A（10.0%）and group C（7.5%）（χ^2 =11.491,P=0.021）.There were no statistically significant differences in neonatal Apgar score among three groups（F=10.062,P=0.017）.Conclusion Tramadol and dezocine can effectively prevent shivering during cesarean section and had no effect on the Apgar score,but tramadol incidence of nausea and vomiting was sig-nificantly higher than that of Dezocine,which is recommended for clinical use to rank and file Sim prevent cesarean section shivering response.