不同剂量右美托咪定防治腰麻剖宫产术中牵拉反应的效果

Effect of different dose of dexmedetomidine in preventing visceral traction reaction during caesarean section under spinal anesthesia

目的探讨静脉单次泵注不同负荷剂量右美托咪定防治腰麻剖宫产术中牵拉反应的效果。方法腰麻下行剖宫产术的足月初产妇200例,随机分为四组,每组50例。断脐后2 min,D1、D2、D3组分别给予右美托咪定0.6、0.8、1.0μg/kg静脉泵入,时间设定为10 min,C组给予相同剂量的生理盐水。记录给药前(T0)、给药后10 min(T1)及探查清理腹腔(T2)时产妇的SBP、DBP、HR、Ramsay评分及牵拉痛情况。结果 T0、T1时四组患者牵拉反应分级差异无统计学意义。T2时C组和D1组牵拉反应分级明显高于D2组和D3组(P<0.05)。T1、T2时D2组和D3组Ramsay镇静评分明显高于D1组与C组(P<0.05)。T1时D3组SBP、DBP明显高于其它三组,HR明显慢于其它三组(P<0.05)。T2时C组和D1组SBP、DBP明显高于D2组和D3组,HR明显快于D2组和D3组(P<0.05)。结论右美托咪定0.8μg/kg可有效抑制蛛网膜下腔阻滞下剖宫产术中牵拉反应,且对循环影响较小。

Objective To investigate the effect of different dose of dexmedetomidine for preventing the visceral traction reaction during caesarean section under spinal anesthesia. Methods Two hundred ASA physical status Ⅰ-Ⅱ patients,full-term primiparas scheduled for elective cesarean section were enrolled in this randomized,placebo-controlled study. Patients were randomly allocated to receive dexmedetomidine in four groups： group C（ 0. 9% normal saline）,group D1（ dexmedetomidine 0. 6 μg / kg）,group D2（ dexmedetomidine 0. 8 μg / kg）,group D3（ dexmedetomidine 1. 0 μg / kg）,50 cases in each group.Two minutes after cutting umbilical,groups D1,D2,D3 received an intravenous infusion single-dose of0. 6,0. 8,1. 0 μg / kg dexmedetomidine respectively for 10 minutes. Group C was injected the same dose of saline. Maternal blood pressure（ BP）,heart rate（ HR）,Ramsay scores,visceral traction reaction conditions were recorded at three points： before iv（ T0）,10 min after iv（ T1） and abdominal exploration（ T2）.Results As for the inhibition of visceral traction pain,groups D2 and D3 were obviously better than groups D1 and C,and there was no statistically significant difference between groups D2 and D3 at T2（ P〈0. 05）.The effects of slowing down heart rate and increasing blood pressure were weaker in group D2 than that in group D3 at T2. Ramsay scores were higher in groups D2 and D3 than in groups D1 and C（ P〈0. 05）,and there was no significant difference between groups D2 and D3 at T2. Conclusion Administration of dexmedetomidine 0. 8 μg / kg could alleviate the visceral traction reaction and had little effect on maternal hemodynamics.