右美托咪定减少卡前列素氨丁三醇剖宫产术中不良反应的效果观察

Observation on the effect of dexmedetomidine on reduction of adverse reactions induced by carboprost tromethamine during cesarean section

目的评价右美托咪定预防卡前列素诱发剖宫产术产妇不良反应的效果。方法将拟行子宫下段剖宫产术产妇随机分为右美托咪定组(D组)、昂丹司琼组(O组)和对照组(C组)各30例,均在连续硬膜外麻醉下完成手术,并于胎儿娩出后静脉输注20 U催产素,10 min后三角肌注射卡前列素氨丁三醇250μg。D组于卡前列素给药前10 min开始静脉输注右美托咪定(负荷量1μg/kg,10 min内输完,随后以0.4μg·kg^(-1)·h^(-1)输注至术毕),O组胎儿娩出后即静脉注射昂丹司琼4 mg,C组以等容量生理盐水替代。记录入室静卧5 min(基础值,T0)、注射卡前列素氨丁三醇后5 min(T1)、手术结束时(T2)的MAP、HR和Sp O2,从使用卡前列腺素氨丁三醇至手术结束恶心、呕吐、胸闷、面色潮红等发生情况,并在手术结束和术后2 h(T3)时进行警觉与镇静(改良OAA/S)评分。结果与D组比较,C组和O组在T1和T2时MAP明显升高,HR明显增快,Sp O2明显降低,差异有统计学意义(P<0.05);与C组比较,D组胸闷、面色潮红、恶心、呕吐的发生率均明显降低,O组恶心、呕吐的发生率明显降低,差异有统计学意义(P<0.05);与C组比较,D组OAA/S评分明显升高(P<0.05)。结论剖宫产术中,卡前列素给药前静脉输注右美托咪定可预防卡前列素诱发的产妇胃肠道和心血管不良反应的发生,效果优于昂丹司琼。

Objective To evaluate the preventive effect of dexmedetomidine on adverse reactions induced by earboprost tromethamine during cesarean section. Methods The pregnant women preparing for low-segment cesarean section were randomly divided into group D （dexmedetomidine）, group O （ondansetron）, and group C （control group） , 30 women in each group. Cesarean section was completed in all the cases under continual epidural anesthesia, then they were treated by intravenous transfusion of 20 U oxytocin after deliv- ery and deltoideus triangularis injeclion of 250 μg carboprost tromethamine. The cases in group D were treated by intravenous transfusion of dexmedetomidine （load capacity 1 μg/kg, the duration time of intravenous transfllsion was less than 10 minutes, the infusion speed was 0.4 μg·kg^-1·h^-1） before 10 minutes of carboprost tromethamine treatment. The cases in group C were treated by intravenous injection of ondansetron after delivery. The cases in group C were treated by normal saline at equal quantity. Mean arterial blood pressure （ MAP）, heart rate, and SpO2 at 5 minutes after entering operation room （baseline, TO）, 5 minutes after injection of carboprost tromethamine （TI）, and the end of surgery （T2） were recorded. The incidence rates of nausea, vomiting, chest distress, and flushed face from usage of carboprost tromethamine to end of surgery were calculated. Modified OAA/S scoring was conducted at T2 and after 2 hours of surgery （T3） . Results Compared with group D, MAP at T2 and T3 in group C and grnup O increased significantly, heart rates at T2 and T3 in group C and group O fastened significantly, SpO2 at T2 and T3 in group C and group O decreased significantly, there were statistically significant differences （P〈0. 05） . Compared with group C, the incidence rates of chest distress, flushed face, nausea, and vomiting in group D decreased signifi- cantly, the incidence rates of nausea and vomiting in group O decreased significantly, there were statistically significant differences （P〈 0. 05） . Compared with group C, OAA/S score in group D increased significantly （P〈0. 05） . Conclusion Intravenous transfusion of dexrnedetomidine before carboprost tromethamine during cesarean section can prevent gastrointestinal and cardiovascular reactions caused by carboprost, the effect is superior to ondansetron.