不同剂量右美托咪啶硬膜外麻醉对剖宫产产妇血流动力学及寒战发生的影响

Effects of epidural anesthesia with different doses of dexmedetomidine during cesarean section of women on their hemodynamics and incidence of chills

目的:探究不同剂量右美托咪啶硬膜外麻醉对剖宫产术产妇血流动力学及寒战发生率的影响。方法:选取2019年1月-2022年6月我院拟行剖宫产产妇112例,随机分为高剂量组(37例)、中剂量组(37例)、低剂量组(38例),分别给予右美托咪定0.2μg/kg、0.5μg/kg、0.8μg/kg,对比3组术中麻醉前(T1)、给药5min后(T2)、切皮时(T3)、术毕(T4)血流动力学[收缩压(SBP)、心率(HR)]、比较3组镇痛效果及苏醒质量[完全阻滞时间、Steward苏醒评分],3组围麻醉期寒战程度及不良反应发生情况,产后生殖裂孔及盆底情况[生殖裂孔直径(LHD)、肛提肌尿道间隙(LUG)]。结果:低剂量组术中SBP和HR波动幅度、麻醉期寒战发生率(35.1%)、LHD、LUG高于中剂量组(13.5%)和高剂量组(13.2%),Steward苏醒评分(3.61±1.02分)低于中剂量组(4.37±1.28分)和高剂量组(4.51±1.37分),剂量组和高剂量组上述指标均无差异。不良反应总发生低剂量组(8.1%)、中剂量组(10.8%)低于高剂量组(34.2%)(均P<0.05)。结论:右美托咪定0.5μg/kg/h应用于硬膜外麻醉剖宫产术中,可稳定产妇血流动力学,镇痛效果良好,降低寒战及不良反应发生风险,保证产妇苏醒质量,改善产后生殖裂孔及盆底情况。

Objective:To explore the effects of epidural anesthesia with different doses of dexmedetomidine during ce-sarean section of women on their hemodynamics and incidence rate of chills.Methods:112 pregnant women who wan-ted cesarean section were selected and were randomly divided into group A(37 cases),group B(37 cases),and group C(38 cases)between January 2019 and June 2022.Dexmedetomidine of 0.2pug/kg,dexmedetomidine of 0.5pg/kg,and dexmedetomidine of 0.8μg/kg were given the women in group A,in group B,and in group C during cesarean section,respectively.The values of hemodynamics indexes,such as systolic blood pressure(SBP)and heart rate(HR),before anesthesia(T1),after 5 min of administration(T2),at skin incision(T3),and at the end of surgery(T4),the analgesic effect and recovery quality,such as complete block time and Steward recovery score,the degree of chills during peri-anesthesia period and occurrence of adverse reactions,and the values of postpartum levator hiatus and pelvic floor inde-xes,such as levator hiatus diameter(LHD)and levator urethral gap(LUG)of the women were compared among the three groups.Results:The change amplitude of the SBP and HR values,and the LHD and LUG levels of the women in group A were significantly higher than those of the women in group B and those of the women in group C,the inci-dence of chills during anesthesia(35.1%)of the women in group A was significantly higher than that(13.5%)of the women in group B and that(13.2%)of the women in group C.The Steward recovery score(3.61±1.02 points)of the women in group A was significantly lower than that(4.37±1.28 points)of the women in group B and that(4.51±1.37 points)of the women in group C,but which of the women in group B had no significantly different from thoseof the women in group C.The total occurrence of adverse reactions of the women in group A(8.1%)or in group B(10.8%)was significantly lower than that(34.2%)of the women in group C(all P<0.05).Conclusion:Dexmedetomi-dine of O.5μg/kg·h used in cesarean section under epidural anesthesia of the women can stabilize their intraoperativehemodynamics,and which has good analgesic effect,can reduce the risk of chlls and adverse reactions,can ensure thematernal recovery quality,and can improve the postpartum levator hiatus and pelvic floor condition.