右美托咪定滴鼻预防再次剖宫产术中牵拉痛的临床效果

Efficacy of nasal drop applications of dexmedetomidine in preventing traction pain during re-cesarean section

目的观察右美托咪定滴鼻预防再次剖宫产术中牵拉痛的效果。方法选择该院因疤痕子宫行择期剖宫产术的产妇80例,分为右美托咪定组(D组)和生理盐水组(C组),每组40例,分别于连续硬膜外麻醉前10 min左右给予1 mL(100μg)右美托咪定和1 mL生理盐水滴鼻。记录两组右美托咪定或生理盐水滴鼻至新生儿娩出时间(T)、术者行牵拉腹膜操作时产妇牵拉痛视觉模拟量表(VAS)评分、心率变化值(ΔHR);记录新生儿娩出后脐动脉血气分析值及1、5 min Apgar评分。若产妇提出镇痛要求,新生儿娩出断脐后即刻静脉注射1 mg布托啡诺补救镇痛治疗,记录补救镇痛率。结果两组产妇T、新生儿脐动脉血pH值、二氧化碳分压(PCO2)、氧分压(PO2)、碳酸氢根离子(HCO3-)水平,以及新生儿娩出后1、5 min Apgar评分比较,差异均无统计学意义(P>0.05)。与C组比较,D组产妇VAS评分、ΔHR及静脉补救镇痛率降低,差异均有统计学意义(P<0.05)。结论右美托咪定滴鼻可预防再次剖宫产术产妇牵拉痛。

Objective To observe the efficacy of nasal drop applications of dexmedetomidine in preventing traction pain during re-cesarean section.Methods A total of 80 women with scar uterus who underwent elective cesarean section in this hospital were selected and divided into the dexmedetomidine group(group D)and the saline group(group C),with 40 cases in each group.Puerperas in group D and group C were treated with nasal drop applications of 1 mL(100μg)dexmedetomidine and 1 mL saline 10 min before receiving continuous epidural anesthsia,respectively.The time between intranasal dexmedetomidine or saline and delivery of the newborn(T),the visual analogue scale(VAS)score of traction pain and value of heart rate change(ΔHR)when operator performed peritoneal stretch,the vlues of neonatal umbilical arterial blood gas analysis,and Apgar scores at 1,5 min after delivery were recorded.Intravenous injection of 1 mg butorphanol for remedy analgesia was performed after delivery if necessary,and the remedial analgesic rate was recorded.Results No statistically significant difference was found in T,neonatal umbilical arterial blood pH,partial oxygen pressure(PO2),bicarbonate ion(HCO3-)level,and Apgar scores at 1,5 min after delivery between the two groups(P>0.05).Compared with group C,the VAS score of traction pain,value ofΔHR and intravenous remedial analgesic rate in group D were decreased,there were statistically significant differences(P<0.05).Conclusion Nasal drop applications of dexmedetomidine could prevent traction pain in re-cesarean section.