地佐辛对剖宫产术中卡前列素氨丁三醇不良反应的预防效果及对血流动力学的影响

Effect of dezocine on carboprost tromethamine adverse reaction and hemodynamics during cesarean section

目的分析地佐辛对剖宫产术中卡前列素氨丁三醇(商品名:欣母沛)不良反应的预防效果及对血流动力学的影响。方法选择首都医科大学附属北京妇产医院2017年1-10月收治的100例剖宫产术患者,采用随机数字表法分为对照组和观察组,各50例。2组均予蛛网膜下腔硬膜外联合麻醉,于胎儿娩出后静脉滴注10 U缩宫素,并于宫体注射250μg卡前列素氨丁三醇;同时观察组即刻入莫非壶静脉滴注10 mg(2 ml)地佐辛,对照组予以2 ml 0.9%氯化钠注射液。观察并记录2组产妇入室时(T_0)、注射卡前列素氨丁三醇后5 min(T_1)、10 min(T_2)、20 min(T_3)和手术结束时(T_4)的血流动力学变化,术中输液量和升压药使用量,以及术中不良反应的发生情况。结果观察组有4例、对照组有6例因需要复合其他类缩血管药物而退出研究。对照组T_1～T4各时点血压较T_0时明显下降(P<0.05);观察组T_2、T_3、T_4时收缩压明显高于对照组[(109±10)mmHg(1 mmHg=0.133 kPa)比(100±10)mmHg、(114±9)mmHg比(100±10)mmHg、(119±10)mmHg比(98±10)mmHg],T_3、T_4时舒张压明显高于对照组[(76±10)mmHg比(65±9)mmHg、(78±9)mmHg比(62±9)mmHg],差异均有统计学意义(均P<0.05)。对照组T_1、T_2时心率较T_0时明显升高(P<0.05)。观察组术中心率变化不明显(P>0.05)。观察组术中输液量和去氧肾上腺素使用量明显少于对照组[(910±68)ml比(1 410±129)ml、(310±48)μg比(935±154)μg](P<0.05)。观察组面部潮红、胸闷、恶心呕吐的发生率均明显低于对照组[8.7%(4/46)比34.1%(15/44)、6.5%(3/46)比86.4%(38/44)、4.3%(2/46)比65.9%(29/44)],头晕的发生率明显高于对照组[71.7%(33/46)比4.5%(2/44)],差异均有统计学意义(均P<0.05)。结论地佐辛对剖宫产术中卡前列素氨丁三醇不良反应的预防效果肯定,能够减少产妇的不适感,更有利于血流动力学的平稳,减少不良反应的发生。

Objective To analyze the effect of dezocine on carboprost tromethamine（hemabate） adverse reaction and hemodynamics during cesarean section. Methods Totally 100 women undergoing cesarean section under spinal and epidural anesthesia from January to October 2017 in Beijing Obstetrics and Gynecology Hospital, Capital Medical University were randomly divided into observation group and control group, with 50 cases in each group. Both groups had intravenous infusion of 10 U oxytocin and intrauterine injection of 250 μg hemabate after childbirth. After hemabate injection, the observation group had intravenous infusion of 10 mg（2 ml） dezocine and the control group had 2 ml 0.9% sodium chloride injection. Hemodynamic changes were observed during operation （T0： after entering the operation room, T1： 5 min after hemabate injection, T2： 10 min after hemabate injection, T3： 20 min after hemabate injection, T4： at the end of operation）. Intraoperative infusion volume, vasopressor dosage and adverse reactions were analyzed. Results Four patients in observation group and 6 patients in control group were withdrawn from research. Blood pressure in control group at T1-T4 was significantly lower than that at T0（P＜0.05）. Systolic blood pressures at T2, T3, T4 in observation group were significantly higher than those in control group［（109±10）mmHg vs （100±10）mmHg, （114±9）mmHg vs （100±10）mmHg, （119±10）mmHg vs （98±10）mmHg］（P＜0.05）. Diastolic blood pressures at T3, T4 in observation group were significantly higher than those in control group［（76±10）mmHg vs （65±9）mmHg, （78±9）mmHg vs （62±9）mmHg］（P＜0.05）. Heart rate in control group at T1, T2 was significantly higher than that at T0（P＜0.05）. Heart rate in observation group showed no significant difference during operation（P＞0.05）. Intraoperative infusion volume and phenylephrine dosage in observation group were significantly less than those in control group［（910±68）ml vs （1 410±129）ml, （310±48）μg vs （935±154）μg］（P＜0.05）. Incidences of congested cheek, chest distress, nausea and vomiting in observation group were significantly lower than those in control group［8.7%（4/46） vs 34.1%（15/44）, 6.5%（3/46） vs 86.4%（38/44）, 4.3%（2/46） vs 65.9%（29/44）］（P＜0.05）. Incidence of dizziness in observation group was significantly higher than that in control group［71.7%（33/46） vs 4.5%（2/44）］（P＜0.05）. Conclusion Dezocine has preventive effect on hemabate adverse reaction and hemodynamic fluctuation during cesarean section.