硬膜外注射和静脉输注右美托咪定用于二次剖宫产手术麻醉效果比较

Clinical comparison of dexmedetomidine for anesthesia of women during the second cesarean section between epidural injection and intravenous infusion

目的:比较硬膜外注射和静脉输注右美托咪定在二次剖宫产术中的麻醉效果差异。方法:选择2019年1月—2020年3月本院进行二次剖宫产手术的产妇85例,随机分为观察组45例、对照组40例。观察组围手术期采用硬膜外注射右美托咪定,对照组静脉输注右美托咪定。比较两组麻醉起效时间、达最高阻滞平面时间、感觉阻滞时间、镇静评分、镇痛持续时间、镇痛药物消耗量、第二产程时间及新生儿Apgar评分与不良反应。结果:观察组麻醉起效时间(6.3±1.0 min)和达最高阻滞平面时间(13.1±1.7 min)均少于对照组(8.7±1.3 min、17.3±2.1 min),感觉阻滞时间(387.8±7.7 min)长于对照组(295.7±3.6 min),镇痛持续时间(159.6±13.6 min)长于对照组(146.3±10.3 min),镇痛药物消耗量(3.2±0.4 ug)及第二产程时间(65.4±15.3 min)均少于对照组(3.6±0.6 ug、82.7±16.6 min)(P均<0.05);两组镇静评分及新生儿Apgar评分无差异(P>0.05);观察组并发症发生率(8.9%)低于对照组(25.0%)(P<0.05)。结论:二次剖宫产术中,右美托咪定联合罗哌卡因硬膜外注射和静脉输注对产妇镇静效果类似,均不会对新生儿造成影响。但硬膜外注射麻醉起效更快,镇痛效果更好,有更高的安全性。

Objective:To analyze the difference of anesthetic effect of epidural injection and intravenous infusion of dexmedetomidine of women during the second cesarean section.Methods:From January 2019 to March 2020,85 pregnant women who would undergo the second cesarean section were selected and were randomly divided into observation group(45 cases)and control group(40 cases).The women in the observation group were given dexmedetomidine by epidural injection before operation,while the women in the control group were given dexmedetomidine by intravenous infusion before operation.The time of anesthesia onset,the time of anesthesia level to reach the highest,the time of sensory anesthesia,the sedation score,the analgesia duration,the analgesic drug consumption,the duration of the second stage of labor,Apgar score of newborn,and the rate of adverse reactions of the women were compared between the two groups.Results:The onset time of anesthesia(6.3±1.0 min)and the time of anesthesia level to reach the highest(13.1±1.7 min)of the women in the observation group were significant lower than those(8.7±1.3 min and 17.3±2.1 min)of the women in the control group,but the sensory block time(387.8±7.7 min)of the women in the observation group was significant longer than that(295.7±3.6 min)of the women in the control group(all P<0.05).The duration of analgesia(159.6±13.6 min)of the women in the observation group was significant longer than that(146.3±10.3 min)of the women in the control group.The analgesic drug dosage(3.2±0.4 ug)and the second labor time(65.4±15.3 min)of the women in the observation group were significant lower than those(3.6±0.6 ug and 82.7±16.6 min)of the women in the control group(all P<0.05).There were no significant differences in the sedation score and neonatal Apgar score between the two groups(P>0.05).The incidence of complications(8.9%)of the women in the observation group was significant lower than that(25.0%)of the women in the control group(P<0.05).Conclusion:During the second cesarean section,ropivacaine combined with epidural injection or intravenous infusion of dexmedetomidine has the similar sedative effects,and both has not adverse affect for the newborn.However,epidural injection of dexmedetomidine combined with ropivacaine has faster onset time of anesthesia and better analgesic effect with higher safety.