右美托咪定在早发型重度子痫前期产妇剖宫产术后的应用研究

Application of dexmedetomidine in early onset severe preeclampsia puerpera after cesarean section

目的观察比较右美托咪定和咪达唑仑在早发型重度子痫前期产妇剖宫产术后镇静的临床应用疗效。方法选取30例早发型重度子痫前期剖宫产产妇,随机分为对照组(咪达唑仑组)、观察组(右美托咪定组)。所有入组产妇在蛛网膜下腔麻醉(腰麻)联合连续硬脊膜外阻滞麻醉下行剖宫产术,镇痛泵镇痛。术后观察组产妇泵入右美托咪定注射液,对照组泵入咪达唑仑注射液,持续泵入24 h,调节药物速度使Ramsay镇静评分维持在2~4分。记录两组产妇术前(T0)、用药前(T1)、用药后1 h(T2)、用药后6 h(T3)、用药后12 h(T4)、用药后24 h(T5)这6个时间点的收缩压(SP)、舒张压(DP)、心率(HR)、呼吸频率(RR)、血氧饱和度(SpO2),记录镇静评分Ramsay2分到达时间、停药后清醒时间、用药后1~2 h内干预次数、24 h内不良反应,记录镇痛视觉模拟评分(VAS)≥3分、患者舒适度≥8分发生情况。结果对照组、观察组产妇收缩压、舒张压在T1、T2、T3、T4、T5明显低于T0,差异有统计学意义(P<0.05),而各组间比较差异无统计学意义(P>0.05)。观察组心率在T2、T3、T4、T5明显低于其T0、T1,差异有统计学意义(P<0.05);观察组心率在T2、T3、T4、T5分别明显低于对照组T2、T3、T4、T5,差异有统计学意义(P<0.05)。对照组、观察组呼吸频率、血氧饱和度在T0、T1、T2、T3、T4、T5比较差异无统计学意义(P>0.05)。观察组产妇Ramsay 2分到达时间长于对照组(P<0.05)。观察组停药后清醒时间短于对照组(P<0.05)。观察组用药后1~2 h内干预次数少于对照组(P<0.05)。观察组术后24 h内不良反应发生率低于对照组(P<0.05),镇痛效果及产妇舒适度明显优于对照组(P<0.05)。结论右美托咪定和咪达唑仑在早发型重度子痫前期产妇剖宫产术后24 h均能提高镇静效果,血液动力学均较平稳;但右美托咪定组术后镇痛效果、产妇舒适度明显优于咪达唑仑组,且右美托咪定具有停药后清醒时间短、用药后24 h内不良反应少等优点。

【Objective】To observe and compare the clinical effect of dexmedetomidine and midazolam on sedation after cesarean section in early onset severe preeclampsia.【Methods】Thirty primiparas with early onset severe preeclampsia were randomly divided into control group(midazolam group)and observation group(dexmedetomidine group).All the parturients underwent cesarean section under the combined spinal and epidural anesthesia,and all of them were given analgesia pump.After the operation,the observation group received dexmedetomidine injection,the control group received midazolam injection,which lasted for 24 hours,and the drug speed was adjusted to maintain Ramsay Sedation score at 2-4 points.The systolic blood pressure(SP),diastolic blood pressure(DP),heart rate(HR),respiratory rate(RR),saturation of blood oxygen,arrival time of Ramsay 2 score,wake-up time after withdrawal,intervention times within 1-2 hours,adverse reactions within 24 hours,and the incidence of VAS analgesic score≥3,patient comfort≥8 were recorded.【Results】The systolic and diastolic blood pressure of the control group and the observation group in T1,T2,T3,T4,T5 were significantly lower than that in T0(P<0.05),but there was no significant difference between the two groups(P>0.05).The heart rate of the observation group in T2,T3,T4,T5 was significantly lower than that in T0,T1,with statistical difference(P<0.05);the heart rate of the observation group in T2,T3,T4,T5 was significantly lower than that of the control group in T2,T3,T4,T5,with statistical difference(P<0.05).There was no significant difference in respiratory rate and blood oxygen saturation between the control group and the observation group in T0,T1,T2,T3,T4 and T5(P>0.05).The arrival time of Ramsay 2 in the observation group was significantly longer than that in the control group(P<0.05).The awake time of the observation group was significantly shorter than that of the control group(P<0.05).The intervention times in 1-2 hours after treatment in the observation group were significantly less than that in the control group(P<0.05).The incidence of adverse reactions within 24 hours after operation in the observation group was significantly lower than that in the control group(P<0.05),and the analgesic effect and the comfort degree of parturient was significantly better than that in the control group(P<0.05).【Conclusion】Dexmedetomidine and midazolam can improve the sedative effect 24 hours after cesarean section,and the hemodynamics is stable.But dexmedetomidine group is better than midazolam group in postoperative analgesia and comfort,and dexmedetomidine has the advantages of short wake-up time and less adverse reactions within 24 hours after medication.