围术期输注右美托咪定对剖宫产病人术后恢复质量的影响

Effect of perioperative infusion of dexmedetomidine on postoperative quality of recovery QoR-40 in patients undergoing cesarean section

目的探讨围术期输注右美托咪定(Dex)对剖宫产病人术后恢复质量(QoR-40)的影响。方法选取2019年6月至2019年11月徐州医科大学附属医院择期腰硬联合麻醉下行剖宫产手术的病人64例,按随机数字表法分为观察组和对照组,每组32例。在胎儿娩出断脐后,观察组病人予Dex 0.5µg/kg泵注10min,随后以0.5µg·kg^(-1)·h^(-1)泵注至手术缝皮结束,对照组给予静脉输注同等体积的生理盐水,术后均行PCIA自控镇痛(均加生理盐水配置至总容量100 mL),观察组:Dex 2µg/kg+舒芬太尼1.5µg/kg+托烷司琼6 mg,对照组:舒芬太尼1.5µg/kg+托烷司琼6 mg。记录产妇术后d1、d3、d5的QoR-40得分、FS-14疲劳评分及相关不良反应。结果与对照组比较,观察组产妇术后d3的QoR-40评分显著升高[(174.1±11.6)分比(179.9±7.1)分,P<0.05],术后d1、d3、d5的FS-14疲劳评分显著降低(P<0.05)。观察组产妇在术后d1的疼痛感受评分上及在术后d3的情绪评分及疼痛感受评分上明显高于对照组(P<0.05),而两组产妇在术后不同时间点的身体舒适度、身体独立能力及病人支持评分方面差异无统计学意义(P>0.05)。与对照组比较,观察组产妇在术后寒颤及恶心、呕吐不良反应发生率明显降低(P<0.05),两组新生儿术后不良反应发生率差异无统计学意义(P>0.05)。结论围术期输注Dex可以提高剖宫产病人术后d3的QoR-40得分,改善产妇的术后疲劳,降低术后不良反应发生率,从而提高产妇术后恢复质量。

Objective To study the effect of perioperative infusion of dexmedetomidine(Dex)on the postoperative quality of recov‐ery QoR-40 in patients undergoing cesarean section.Methods Sixty-four patients undergoing selective cesarean section under com‐bined spinal-epidural anaesthesia in Affiliated Hospital of Xuzhou Medical University from June 2019 to November 2019 were selected and randomly divided into the group D and the group C,with 32 cases in each group.After delivery and cord clamping,0.5µg/kg Dexwas pumped for 10 minutes in group D,followed by 0.5µg·kg^(-1)·h^(-1) to the end of surgical suture skin.Group C was given intravenous in‐fusion of the same volume of normal saline.All patients received patient-controlled analgesia with PCIA after operation(all patients were allocated to total volume 100 mL).Group D:Dex 2µg/kg+sufentanil 1.5µg/kg+tropisetron 6 mg,Group C:sufentanil 1.5µg/kg+tropisetron 6 mg.The QoR-40 score,FS-14 fatigue score and related adverse reactions were recorded on the 1st,3rd and 5th day after operation.Results Compared with group C,the QoR-40 score of group D was significantly higher on the 3rd day after operation[(174.1±11.6)vs.(179.9±7.1)],and the FS-14 fatigue score on the 1st,3rd and 5th day after operation was significantly lower than that of group C(P<0.05).In group D,the pain perception score on the 1st postoperative day and the emotional score and pain perception score on the 3rd day after operation were significantly higher than those in the group C(P<0.05).There was no significant difference in physical comfort,physical independence and patient support scores between the two groups at different time after operation(P>0.05).Compared with group C,the incidence of postoperative shivering,nausea and vomiting in group D was significantly lower(P<0.05),but there was no significant difference in the incidence of postoperative adverse reactions between the two groups of neonates(P>0.05).Conclusion Perioperative infusion of Dex can improve the QoR-40 score of patients on the 3rd day after cesarean section,improve postoperative fatigue,reduce the incidence of postoperative adverse reactions,and improve the quality of postoperative recovery.