右美托咪啶用于剖宫产全身麻醉对新生儿和子宫收缩的影响

Neonatal effects and uterine contraction of dexmedetomidine in the cesarean section under general anesthesia

目的探讨右美托咪啶（Dex）用于剖宫产全身麻醉中的效果以及对母婴和子宫收缩的影响。方法选择单胎足月妊娠拟在全身麻醉下行子宫下段剖宫产术的患者40例。ASA分级Ⅰ或Ⅱ级。采用随机数字表法，将患者分为右美托咪啶组（D组）和生理盐水组（N组），每组20例。D组麻醉诱导前10min持续输注右美托咪啶0．6μg／kg，继以0．4μg／（kg·h）持续输注，手术关腹时停药；N组泵入等体积的生理盐水。胎儿娩出后，抽取脐静脉血进行血气分析；记录新生儿1、5min时的Apgar评分；记录出血量、尿量和缩宫素的用量，评估产后子宫收缩情况和拔除气管导管的质量。结果两组脐静脉血气分析、新生儿出生后1、5min时的Apgar评分比较差异均无统计学意义（P〉0．05）。与N组比较，D组患者的出血量少[（226．8±55．9）mlvs（315．1±80．0）ml，P〈0．01]，尿量多[（380．2±169．0）mlvs（250．3±109．1）ml，P〈0．05]，静脉注射缩宫素的用量少[（2．8±2．6）Uvs（5．6±4．0）U，P〈0．05]，产后子宫收缩评分低（P〈0．05），拔除气管导管时的质量评级低（P〈0．05）。结论右美托咪啶复合全身麻醉用于剖宫产术的麻醉效果较好且对母婴无明显不良影响。

Objective To investigate the neonatal effects and uterine contraction of dexmedetomi- dine in the cesarean section under general anesthesia. Methods Forty American Society of Anesthesiologists （ASA） Ⅰ or Ⅱ parturients with a single baby at full term in vertex presentation, scheduled for caesarcan section under general anesthesia, were randomly divided into two groups： Group dexmedetomidine （ Group D ; n = 20） and group normal saline （ Group N; n = 20 ） using a computer-generated randomization list. The group D received an intravenous infusion loading dose of 0. 6 μg/kg of dexmedetomidine, starting 10 min before induction of anesthesia, following with an intravenous infusion 0. 4 μg/（ kg · h） of dexme- detomidine until peritoneal closure. The group N received an intravenous infusion of isovolumic of normal saline. The umbilical vein blood was drawn for gas analysis, and the Apgar scores at I and 5 rain were also recorded after delivery. The blood toss, the urinary volume, and the dosage of oxytoein were recorded. The uterine contraction and the quality of tracheal extubation were assessed. Results No statistical differences were found about the umbilical vein blood gas analysis and the Apgar scores at 1 and 5 min after delivery （P 〉0. 05）. Compared to group N, patients in group D had less blood loss [ （226. 8 ±55.9）ml vs （315.1 ± 80. 0） ml, P 〈 0. 01 ], more urinary volume [ （380. 2 ± 169. 0） ml vs （250. 3 ± 109. 1 ） ml, P 〈 0. 01 ], less supplementary oxytocin [ （2. 8 ± 2. 6 ） U vs （ 5.6±4.0） U, P 〈 0.05 ], lower degree of uterine con- traction （ P 〈 0.05 ） and better quality of tracheal extubation （ P 〈 0. 05 ）. Conclusions The efficacy of dexmedetomidine combined general anesthesia is better for cesarean section without obvious adverse effectson parturients and neonates.