右美托咪定在妇产科手术麻醉中的应用进展

Application of dexmedetomidine in anesthesia in gynecologic surgery

右美托咪定(dexmedetomidine,Dex)作为新型高选择性的a2肾上腺素受体(a2adrenergicreceptor,a2-AR)激动剂,与a_2-AR的亲和力为可乐定的8倍,可广泛作用于哺乳动物的大脑、脊髓及外周的a_2-AR,从而激动与a_2-AR偶联的G蛋白,阻滞交感神经,产生镇静、催眠、镇痛、抗焦虑、抗交感效应。且具有对呼吸的抑制作用轻、易唤醒的特点。目前被广泛应用于临床麻醉中。妇产科手术麻醉与镇痛具有其特殊性,特别是产科麻醉和镇痛既要保证母婴安全,又要对子宫平滑肌收缩影响轻微,还要最大程度的减轻患者的痛疼,所以药物选择更加慎重。本文拟通过综述的方式介绍Dex在妇产科手术麻醉、分娩镇痛、术后镇痛、无痛流产及在椎管内麻醉中预防寒战,以及不良反应等方面的进展。

Dexmedetomidine（Dex） as a novel A2 adrenergic receptor（a2-AR） agonist has capability of 8 times affinity to a2-AR than clonidine.It can play an important role in the mammalian brain and spinal cord and peripheral a2-AR,so excited and a2-AR G protein coupling,sedation,analgesia,anti anxiety,sympathetic nerve block effect to inhibit the respiratory depression,easy to wake up.Since its listing,has been widely used in clinical anesthesia.Obstetrics and gynecology surgery has its unique characteristics,especially obstetric anesthesia and analgesia both to ensure maternal and child safety,minor effect on uterine smooth muscle contraction,but also to the greatest extent of reducing the patient＇s pain.This paper intends to review the application of Dex in obstetrics and gynecology surgery,including anesthesia,analgesia,postoperative analgesia,painless abortion and childbirth in spinal anesthesia in prevention of shivering,and its adverse effects.