右美托咪啶与布托啡诺预防剖宫产手术寒战效果比较

Comparison of effect on dexmedetomidine and butorphanol for shivering prevention after caesarean operation

目的：比较右美托咪啶与布托啡诺预防剖宫产手术寒战效果。方法：60例择期在椎管内麻醉行剖宫产手术患者,ASAⅠ~Ⅱ级随机分为对照组（C组）、布托啡诺组（T组）、右美托咪啶组（D组）,每组20例。胎儿娩出断脐后T组予布托啡诺0.02mg/kg稀释至10m L恒速10min静脉注射,D组予右美托咪啶0.4μg/kg稀释至10m L恒速10min静脉注射,C组予生理盐水10m L恒速10min静脉注射。观察记录麻醉前（T0）,胎儿剖出即刻（T1）,手术结束时（T2）心率、血压、Ramsay镇静评分、Wrench寒战分级和不良反应发生情况。结果：三组T0及T1时血压、心率组间比较无显著差异（P〉0.05）,T2时D组HR较T0时减慢（P〈0.05）,较C组、T组也明显减慢（P〈0.05）。Ramsay镇静评分D组T2时明显高于T0时（P〈0.05）,且显著高于C组、T组（P〈0.05）。D组围术期寒战发生率较D组及T组明显降低（P〈0.05）。D组用药后恶心、呕吐发生情况较C组及T组明显降低（P〈0.05）。结论：在胎儿娩出后即刻给予右美托咪啶0.4μg/kg较布托啡诺更能有效预防剖宫产患者腰麻后寒战反应。

Objective：Comparison of effect on dexmedetomidine and butorphanol for ivering prevention after caesarean operation.Methods：Sixty ASA Ⅰ~Ⅱpatients scheduled for receiving caesarean operation were randomized equally into the control（group C,n=20）,the butorphanol group（group T,n=20） and dexmedetomidine groups（group D,n=20）.The patients in the butorphanol group received continuous infusion of butorphanol（0.02mg/kg,10 m L） at constant velocity in 10 min after delivery,while those in the dexmedetomidine group received dexmedetomidine（0.4μg/kg,10 m L） at the same rate,and those in the control group received normal saline.The mean blood pressure,heart rate,Ramsay sedation score,Wrench shiver score and the side-effects were recorded before anesthesia（T0）,and at the immediately time of fetal childbirth（T1） and at the end of the surgery（T2）.Results：The incidence of shivering after caesarean operation was significantly lower in the dexmedetomidine group（P〈 0.05）,while HR at T2 in the dexmedetomidine group was decreased significantly compared with that in the control group and butorphanol group（P 〈0.05）.The incidence of such adverse effects as nausea and vomiting was significantly lower in the dexmedetomidine group（P〈0.05）.Conclusion：The infusion of dexmedetomidine to the patient after caesarean operation at the immediately time of fetal childbirth is more effective than butorphanol.