硬膜外右美托咪啶辅助腰麻用于二次剖宫产术的麻醉效果

Outcomes of epidural dexmedetomidine plus ropivacaine assisting low-dose spinal anesthesia for parturients in secondary cesarean section

目的:评价右美托咪啶硬膜外辅助腰麻用于二次剖宫产术的效果。方法:单胎足月二次剖宫产产妇60例,随机分为3组,常规腰麻(CON)组、低剂量腰硬联合(L-SE)组、低剂量腰硬联合加右美托咪啶(L-SDE)组。0.5%重比重罗哌卡因蛛网膜下腔注入,CON组15 mg,L-SE和L-SDE组12 mg。随后经硬膜外给予0.9%NaCl、0.75%罗哌卡因或0.75%罗哌卡因+0.5μg/kg右美托咪啶6 mL。记录麻醉起效及维持时间、肌肉松弛度、牵拉反射、术后首次PCA时间。结果:L-SDE组感觉神经阻滞消退、术后首次PCA时间长于CON和L-SE组;牵拉反射、肌肉松弛度低于L-SE组(P<0.05),T1~T4时点HR低于、SBP高于CON组(P<0.05),Ramsay评分高于CON和L-SE组(P<0.05),低血压、恶心呕吐、产妇主诉不适发生率低于CON组(P<0.05),寒战发生率均低于CON和L-SE组(P<0.05)。3组新生儿出生1、5 min Apgar评分、脐静脉血pH值及乳酸值差异无统计学意义(P>0.05)。结论:硬膜外右美托咪啶(0.5μg/kg)辅助低剂量腰麻用于二次剖宫产术,可优化麻醉和镇痛效果。

Objective:To evaluate the efficacy and safety of epidural dexmedetomidine plus ropivacaine as adjuvants to low dose spinal anesthesia for parturients in secondary cesarean section.Methods:Sixty full-term pluripara undergoing secondary cesarean section were randomly assigned to CON group(spinal anesthesia with normal dose),L-SE group(low-dose of ropivacaine for combined spinal-epidural anesthesia)and L-SDE group(epidural dexmedetomidine plus low-dose of ropivacaine for combined spinal-epidural anesthesia)(n=20 in each group).0.5%hyperbaric ropivacaine was injected intrathecally in women in CON group in dose of 15 mg,and in those in L-SE and L-SDE groups in dose of 12 mg.Then 6 mL of dexmedetomidine was administered via the epidural needle(0.9%sodium chloride in the CON group,0.75%ropivacaine in L-SE and 0.75%ropivacaine plus 0.5μg/kg dexmedetomidine in L-SDE).The indicators,including the highest level of sensory block and the time of sensory block regression,the time of the first postoperative PCIA,the outcome of mother and baby,were recorded.Results:The regression time of sensory nerve block and the first time of postoperative PCIA were significantly longer in L-SDE group than in CON and L-SE groups(P<0.05).From T1 to T4,HR were markedly lower,yet SBP was significantly higher than that of CON group(P<0.05).Ramsay score was significantly higher in L-SDE group than in CON and L-SE groups(P<0.05).The incidence of nausea and vomiting,hypotension syndrome was notably lower in L-SDE group than in CON group(P<0.05),yet women in L-SDE group had lower incidence of shivering than those in CON and L-SE groups(P<0.05).There were no significant differences in Apgar score for newborns at 1 minute or 5 minute,umbilical artery blood PH value and lactic acid value among three groups(P>0.05).Conclusion:Epidural dexmedetomidine(0.5μg/kg)plus 0.75%ropivacaine assisting with low-dose spinal anesthesia for parturients in secondary cesarean section can optimize the effect of anesthesia and analgesia without increased adverse effect.