右美托咪定对剖宫产围术期体温及并发寒颤的影响

Effect of dexmedetomidine for body temperature and shivering during cesarean section

目的探讨右美托咪定对于蛛网膜下腔阻滞后剖宫产术围术期体温变化和寒颤的影响。方法选取2017年8-12月急诊或择期行剖宫产手术的足月单胎妊娠孕妇80例,年龄23~45岁,妊娠38~40周,ASAⅠ或Ⅱ级,随机分为右美托咪定组(D组)和对照组(C组),每组40例。胎儿娩出断脐后,D组给予右美托咪定0.5μg·kg^-1·h^-1至缝皮结束,C组则给予生理盐水0.125 ml·kg^-1·h^-1作为对照。记录产妇麻醉前(T1)、断脐后(T2)、术毕(T3)及返回病房(T4)时的膀胱温,并于以上时点采用Wrench寒颤分级法评估寒颤强度分级。术后采用状态焦虑量表对产妇进行焦虑评分。结果与T1时比较,T2-T4时两组膀胱温明显降低(P<0.05)。两组不同时点膀胱温差异无统计学意义。T3、T4时D组寒颤强度分级明显低于C组(P<0.05)。D组术后焦虑评分明显低于C组[(41.1±10.6)分vs(51.6±13.1)分,P<0.05]。结论右美托咪定对预防蛛网膜下腔阻滞后剖宫产患者围术期寒颤和焦虑具有显著效果,但并不能改变患者围术期的低体温率。

Objective To investigate the effect of dexmedetomidine on perioperative shivering and body temperature during cesarean section after subarachnoid anesthesia.Methods Eighty parturients with a single baby at full term in vertex presentation scheduled for caesarean,aged 23-45 years,falling into ASA physical statusⅠorⅡ,were randomly divided into two groups:dexmedetomidine group(group D)and control group(group C)(n=40 each group).After delivery of the baby,parturients in group D were given an intravenous infusion loading dose of 0.5μg·kg^-1·h^-1 until peritoneal closure,while parturients in group C received an intravenous infusion 0.125 ml·kg-1·h-1 of normal saline.The bladder temperature and shivering scores were recorded before anesthesia,after delivery of the baby,at the end of operation and after return to the ward.The anxiety level of parturients was assessed after operation by State Anxiety Inventory.Results Compared with T1,bladder temperature decreased significantly at T2-T4 in the two groups(P<0.05),and there was no significant difference in bladder temperature between the two groups at any different time points.The chill rating in group D was significantly lower than that in group C at T3 and T4(P<0.05).The postoperative state anxiety score in group D was significantly lower than that in group C[(41.1±10.6)scores vs(51.6±13.1)scores,P<0.05].Conclusion Dexmedetomidine has a significant effect on preventing perioperative shiver and anxiety in cesarean section patients after subarachnoid anesthesia,but it can not change the perioperative hypothermia rate.