右美托咪定对妊娠期糖尿病产妇炎症应激反应的影响

Effect of dexmedetomidine on inflammatory stress response of pregnant women with gestational diabetes mellitus

目的:探究妊娠期糖尿病产妇应用右美托咪定对剖宫产手术应激反应的影响。方法:选择本院2018年3月—2019年11月接受剖宫产手术的妊娠期糖尿病患者170例。根据是否蛛网膜下腔注射右美托咪定分为右美托咪定(观察组)和对照组。所有患者均采用2.5ml 0.5%布比卡因蛛网膜下腔麻醉,观察组蛛网膜下腔注入2单位(5μg)右美托咪定(5g),对照组接受等量生理盐水。采用Ramsay镇静评分和VAS评分评定术后不同时间镇静镇痛效果。记录不良反应,手术时间、新生儿Apgar评分。检测术前和术后肾上腺素、去甲肾上腺素、血糖、白细胞介素-6(IL-6),IL-8和肿瘤坏死因子-α(TNF-α)水平。结果:术后8h开始,术后各时间段疼痛评分观察组低于对照组(P<0.05),术后镇静评分两组无差异(P>0.05);术后观察组血浆中肾上腺素、去甲肾上腺素、血糖、IL-6和TNF-α水平均低于对照组,IL-8水平高于对照组(P<0.05)。应用中未发现低血压、心动过缓、呼吸抑制等不良反应,两组麻醉后达到最高阻滞平面时间、新生儿Apgar评分均无差异(P>0.05),观察组恶心呕吐(12.3%)和寒战(8.7%)发生率低于对照组(26.3%、22.2%)(P<0.05)。结论:右美托咪定可有效抑制妊娠期糖尿病产妇术中炎症应激反应的发生,优化了腰硬联合的麻醉效果,降低了术后恶心呕吐和寒战的发生率。

Objective:To explore the effect of dexmedetomidine on stress response during cesarean section of pregnant women with gestational diabetes mellitus(GDM).Methods:170 women with GDM were selected and were divided into observation group and control group according to whether dexmedetomidine injected into subarachnoid space during cesarean section from March 2018 to November 2019.All these women were anesthetized with 2.5 ml 0.5%bupivacaine injected into subarachnoid.The women in the observation group were additional injected with 2 units(5μg)of dexmedetomidine into the subarachnoid space,while the women in the control group were additional injected the same amount of normal saline into the subarachnoid space.Ramsay Sedation score and VAS score were used to evaluate the effect of sedation and analgesia at different time point after operation.Adverse reactions rate and operation time of the women,and the neonatal Apgar score in the two groups were recorded.The levels of epinephrine,norepinephrine,blood glucose,interleukin-6(IL-6),IL-8,and tumor necrosis factor-α(TNF-α)of the women in the two groups were detected before and after operation.Results:From 8 h after operation,the pain score at different time point of the women in observation group was significant lower than that of the women in control group(P<0.05),and there was no significant difference in postoperative sedation score of the women between the two groups(P>0.05).The postoperative levels of epinephrine,norepinephrine,blood glucose,IL-6,and TNF–αof the women in the observation group were significant lower than those of the women in the control group,but the level of IL-8 of the women in the observation group was significant higher(P<0.05).No adverse reactions such as hypotension,bradycardia,and respiratory depression were found in the two groups.There were no significant differences in the time of reaching the maximum block plane and neonatal Apgar score between the two groups(P>0.05).The incidences of nausea and vomiting(12.3%)and chills(8.7%)of the women in the observation group were significant lower than those(26.3%and 22.2%)of the women in the control group(P<0.05).Conclusion:Dexmedetomidine can effectively inhibit the occurrence of inflammatory stress reaction of pregnant women with GDM during cesarean section,which can optimize the anesthesia effect of combined spinal and epidural anesthesia,and reduce the incidences of postoperative nausea,vomiting and shivering.