右美托咪定与舒芬太尼鞘内注射预防剖宫产术腰硬联合麻醉寒颤效果比较

Comparison of intrathecal Dexmedetomidine with Sufentanil as adjuvants for prevention of shivering in cesarean sections undergoing combined spinal epidural anesthesia

目的比较右美托咪定与舒芬太尼鞘内注射预防剖宫产术腰硬联合麻醉相关寒颤的效果。方法选择腰硬联合麻醉下剖宫产术产妇180例,采用随机数字表法分为对照组(C组)、右美托咪定组(D组)和舒芬太尼组(S组)各60例。在行蛛网膜下腔注射布比卡因的同时,S组和D组分别加用舒芬太尼5μg和右美托咪定5μg,C组给予等体积生理盐水,所有组的总体积为3mL;记录寒战的发生及其强度,连续监测血流动力学指标并记录并发症的发生情况。结果 D组寒战的发生率及强度与C组和S组比较的差异有统计学意义(P<0.05);D组瘙痒、恶心呕吐发生率与S组比较的差异有统计学意义(P<0.05);3组患者平均动脉压、心率、新生儿Apgar评分、呼吸抑制比较的差异均无统计学意义(P>0.05)。结论在剖宫产术腰硬联合麻醉中,鞘内注射右美托咪定与舒芬太尼相比,寒颤的发生率及强度低且副作用少,故可安全用于剖宫产术腰硬联合麻醉寒颤的预防。

Objective To compare the effect of intrathecal injection of Dexmedetomidine with Sufentanil for prevention of shivering in cesarean sections undergoing combined spinal epidural anesthesia（CSEA）.Methods In total,180 cases of cesarean section under combined spinal and epidural anesthesia were selected and divided into three groups（n=60）by random number table method：control group（group C）,Dexmedetomidine group（group D）and Sufentanil group（group S）;5μg of Sufentanil and 5μg of Dexmedetomidine were added to group S and D,respectively,while subarachnoid injection of bupivacaine was performed,and normal saline was added to group C.The total volume of all groups was 3 mL;the occurrence and intensity of shivering were recorded,hemodynamic parameters were monitored continuously,and the occurrence of complications was recorded.Results The incidence and intensity of shivering in group D were less than those in group C and S（P〈0.05）,and the incidence of pruritus,nausea and vomiting in group D,compared to group S,was statistically significant（P〈0.05）;The mean arterial pressure,heart rate,neonatal Apgar score,and respiratory depression showed no difference between groups（P〉0.05）.Conclusion Compared with intrathecal injection of Sufentanil,Dexmedetomidine shows less incidence and intensity of shivering in cesarean section undergoing CSEA,and less side effects.Therefore,intrathecal injection of dexmedetomidine is safe for prevention of shivering in cesarean sections under CSEA.