右美托咪定复合氟比洛芬酯预防卡前列素氨丁三醇不良反应的效果

Effect of dexmedetomidine combined with flurbiprofen axetil for preventing adverse effects of carboprosttromethamine druing cesarean delivery

目的探讨剖宫产术中右美托咪定复合氟比洛芬酯预防卡前列素氨丁三醇不良反应的效果。方法选择择期行子宫下段剖宫产术且术前合并宫缩乏力高危因素产妇60例,美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级,年龄24~45岁,体质量50~80 kg,采用随机数字表法分为右美托咪定复合氟比洛芬酯组(D组)和对照组(N组),每组30例。D组年龄(34.22±2.13)岁,体质量(64.14±4.18)kg,身高(158.22±10.19)cm;N组年龄(35.11±3.13)岁,体质量(65.21±4.95)kg,身高(159.84±11.27)cm。两组产妇均采用腰硬联合麻醉,D组在胎儿娩出后子宫体注射卡前列素氨丁三醇前静脉注射氟比洛芬酯,同时持续静脉泵注右美托咪定0.5μg/kg,15 min泵注完毕。记录两组产妇入室休息15 min(基础值,T0)、卡前列素氨丁三醇注射后15 min(T1)、术毕(T2)时平均动脉压、心率和Ramsay镇静评分;记录两组产妇子宫体注射卡前列素氨丁三醇后恶心、呕吐、胸闷胸痛、高血压、心动过速、寒战的发生情况;记录两组产妇需要静脉注射昂丹司琼、布托啡诺补救例数。结果T1时D组MAP、HR分别为(84.40±5.20)mmHg(1 mmHg=0.133 kPa)、(67.25±5.13)次/min,明显低于N组的(92.84±6.12)mmHg、(91.44±6.52)次/min,差异有统计学意义(均P<0.05);D组恶心、呕吐、胸闷胸痛、高血压、心动过速、寒战等不良反应发生率分别为6.67%、0.00%、6.67%、0.00%、0.00%、0.00%,明显低于N组的66.67%、33.33%、56.67%、40.00%、36.67%、33.33%,差异有统计学意义(均P<0.05);T1时D组Ramsay评分明显高于N组(P<0.05),T0、T2时两组MAP、HR和Ramsay评分比较,差异均无统计学意义(均P>0.05);D组需要静脉注射昂丹司琼或布托啡诺补救例数明显降低(均P<0.05)。结论右美托咪定复合氟比洛芬酯能有效降低剖宫产术中应用卡前列素氨丁三醇所致的不良反应。

Objective To investigate the effect of dexmedetomidine combined with flurbiprofen axetil in the prevention of adverse reactions of carprost tromethamine during cesarean section.Methods There were 60 parturients with the risk factors of uterine atony in this study,which underwent full term cesarean section.They were aged from 24 to 45 years old,and ASA physical statusⅠorⅡ.They were randomly divided into a dexmedetomidine combined with flurbiprofen axetil group(group D)and a control group(group N),with 30 patients in each group.The patients in group D were(34.22±2.13)years old,(64.14±4.18)kg in weight,and(158.22±10.19)cm in height.The patients in group N were(35.11±3.13)years old,(65.21±4.95)kg in weight,and(159.84±11.27)cm in height.Combined spinal and epidural anesthesia was used in both groups.In group D,flurbiprofen axetil was injected intravenously before carboprost tromethamine was injected into the uterus after delivery;at the same time,dexmedetomidine was continuously and intravenously injected for 0.5μg/kg,and the injection was completed within 15 minutes.MAP,HR,and Ramsay sedation score were recorded 15 min after going into the operation room(T0),15 min after injecting carboprost tromethamine into uterus(T1),and at end of operation(T2).The adverse reactions of carboprost tromethamine were recorded,as well as the number of cases requiring intravenous injection of ondansetron or butorphanol.Results At T1,the MAP and HR in group D were significantly lower than those in group N[(84.40±5.20)mmHg(1 mmHg=0.133 kPa)vs.(92.84±6.12)mmHg and (67.25±5.13) beats/min vs. (91.44±6.52) beats/min;both P < 0.05]. The incidences of nausea, vomiting, chestdistress and pain, hypertension, tachycardia, and shivering in group D were significantly lower than those in groupN (6.67% vs. 66.67%, 0.00% vs. 33.33%, 6.67% vs. 56.67%, 0.00% vs. 40.00%, 0.00% vs. 36.67%, and 0.00%vs. 33.33%;all P < 0.05). At T1, the Ramsay score was higher in group D than in group N (P < 0.05). At T0 andT1, there were no statistical differences in MAP, HR, and Ramsay score between these two groups (all P > 0.05).The numbers of cases requiring intravenous ondansetron or butorphanol in group D were significantly smallerthan those in group N (both P < 0.05). Conclusion Dexmedetomidine combined with flurbiprofen axetil caneffectively reduce the adverse reactions caused by carboprost tromethamine during cesarean section.