盐酸右美托咪定在妊娠期高血压高龄产妇剖宫产围术期应用效果研究

Study on the effect of dexmedetomidine in the perioperative period of cesarean section in elderly parturients with gestational hypertension

目的观察右美托咪定是否可以增加妊娠期高血压高龄产妇剖宫产术中术后镇痛、镇静程度,维持血流动力学稳定,减轻围术期炎症反应和氧化应激损伤。方法选择接受剖宫产手术的高龄且合并妊娠期高血压疾病的产妇60例,分为右美托咪定组(D组)和对照组(C组),每组30例。D组产妇在胎儿娩出并切断脐静脉后给予盐酸右美托咪定(负荷量0.5μg/kg,维持量0.2μg·kg^(-1)·h^(-1)持续泵注至术毕),C组以同样的方法给予等容量生理盐水。手术结束后连接静脉自控镇痛泵,D组:右美托咪定2μg/kg+舒芬太尼2μg/kg+地佐辛0.3 mg/kg+托烷司琼10 mg+盐水共100 mL;C组:舒芬太尼2μg/kg+地佐辛0.3 mg/kg+托烷司琼10 mg+盐水共100 mL。采集以下指标:①术前(T1)、给药后20 min(T2)、术毕(T3),术后6 h(T4)、24 h(T5)、48 h(T6)Ramsay镇静程度评分、视觉模拟评分(visual analogue scale,VAS);术后镇痛泵按压次数;②T1~T6血流动力学参数;③不良反应发生率;④炎症反应及氧化应激指标:T1~T6静脉血肿瘤坏死因子α(tumor necrosis factor-α,TNF-α)、白细胞介素6(interleukin-6,IL-6)、丙二醛(malondialdehyde,MDA)和超氧化物歧化酶(superoxide dismutase,SOD)浓度。结果D组T2~T6时Ramsay镇静评分明显高于C组,T4~T6时VAS疼痛评分明显低于C组(P<0.05);D组术后镇痛泵按压次数明显低于C组(P<0.05)。D组T2~T6时收缩压、舒张压、心率明显低于C组(P<0.05)。不良反应发生率两组比较差异无统计学意义(P>0.05)。D组T2~T6时TNF-α、IL-6、MDA水平明显低于C组,SOD水平明显高于C组(P<0.05)。结论右美托咪定可以维持妊娠期高血压高龄产妇围手术期血流动力学的稳定,减轻紧张焦虑及疼痛程度,并通过镇痛镇静作用减少炎症反应和氧化应激反应,改善预后。

Objective To observe whether dexmedetomidine can increase the level of analgesia and sedation during cesarean section(C-section)in elderly parturients with gestational hypertension,maintain hemodynamics stability,reduce perioperative inflammatory response and oxidative stress injury.Methods A total of 60 cases of elderly parturients with gestational hypertension who underwent C-section were selected and divided into dexmedetomidine group(group D)and control group(group C),with 30 cases in each group.Group D was given dexmedetomidine hydrochloride(the loading amount was 0.5μg/kg,and the maintenance rate was 0.2μg·kg^(-1)·h^(-1)until the end of operation)after the fetus was delivered and the umbilical vein was cut,and the constant volume of normal saline was given to group C in the same manner.After surgery,the intravenous self-controlled analgesia pump was connected,group D was given dexmedetomidine 2μg/kg+sufentanil 2μg/kg+dezocine 0.3 mg/kg+tropisetron 10 mg+saline 100 mL,while group C was given sufentanil 2μg/kg+dezocine 0.3 mg/kg+tropisetron 10 mg+saline 100 mL.The following indexes were collected:①Ramsay sedation score and visual analogue scale(VAS)before surgery(T1),at 20 min after administration(T2)and immediately after surgery(T3),at 6 h(T4),24 h(T5)and 48 h(T6)after surgery as well as additional times of postoperative analgesia pump;②Hemodynamic parameters at T1-T6;③Incidence of adverse reactions;④Indicators of inflammatory response and oxidative stress:tumor necrosis factor-α(TNF-α),interleukin 6(IL-6),malondialdehyde(MDA)and superoxide dismutase(SOD)in venous blood at T1-T6.Results Ramsay sedation score at T2-T6 in group D was significantly higher than that in group C,VAS pain score at T4-T6 in group D was significantly lower than that in group C(P<0.05).Additional times of postoperative analgesia pump in group D was significantly lower than that in group C(P<0.05).The levels of SBP,DBP and HR in group D at T2-T6 were significantly lower than those in group C(P<0.05).There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).At T2-T6,the levels of TNF-α,IL-6 and MDA in group D were significantly lower than those in group C,and the levels of SOD were significantly higher than those in group C(P<0.05).Conclusion Dexmedetomidine can maintain the stability of perioperative hemodynamics in elderly parturients with gestational hypertension,alleviate anxiety and pain,and reduce inflammatory response and oxidative stress response through analgesia and sedation,thus improving the prognosis.