再次剖宫产术右美托咪定滴鼻预防牵拉痛临床效果

Clinical effect of dexmedetomidine nasal drip for preventing the traction pain during cesarean section again

目的:探究右美托咪定滴鼻预防再次剖宫产术中牵拉痛的临床效果。方法:选取本院2019年1月-2022年6月收治的110例因瘢痕子宫需再次行剖宫产产妇,采用信封随机法分为两组。滴鼻组(n=58)在连续硬膜外麻醉前给予右美托咪定滴鼻,安慰组(n=52)在连续硬膜外麻醉前给予生理盐水滴鼻。统计两组寒战发生情况及新生儿1min Apgar评分≤7分发生率,比较两组入室前(T0)、麻醉10 min(T1)、新生儿娩出时(T2)、术毕(T3)视觉模拟(VAS)评分、血流动力学及Ramsay评分,检测两组新生儿脐动脉血血气分析指标。结果:滴鼻组寒战发生率(10.3%)低于安慰组(25.0%)(P<0.05);VAS评分两组T0时无差异(P>0.05),T1、T2、T3时两组评分均较T0时升高但滴鼻组(2.52±0.41分、2.67±0.47分、2.85±0.52分)低于安慰组(4.07±0.69分、4.34±0.68分、4.12±0.49分)(均P<0.05)。两组血流动力学T0时无差异(P>0.05),T1时两组舒张压(DBP)及安慰组收缩压(SBP)、心率(HR)均较T0时下降,T2时两组SBP、DBP及安慰组HR较T0时下降,T1、T2、T3时滴鼻组及安慰组T3时Ramsay评分较T0时升高,且滴鼻组T2时HR、SBP高于安慰组,T1、T2时DBP高于安慰组,T1、T2、T3时Ramsay评分高于安慰组(均P<0.05)。两组新生儿脐动脉血pH、二氧化碳分压、氧分压及Apgar评分≤7分占比均无差异(P>0.05)。结论:右美托咪定滴鼻可预防再次剖宫产术产妇牵拉痛,降低术中寒战的发生率,稳定血流动力学,对新生儿影响较小。

Objective:To study the elinical efect of dexmedetomidine nasal drip for preventing the traction pain during ccsarcan section again of women.Methods:A total of 110 women who needed to cesarean section again due to their scarred uterus were selected and were divided into two groups by envelope random method from January 2019 to June 2022.58 women in the study group had rceived dexmedetomidine nasal drip before continuous epidural anesthesia,and 52 women in the control group had received saline nasal drip before continuous epidural anesthesia.The incidences of chills of the women and Apgar score≤7 points of the neonates in 1 min after born in the two groups were counted.The visual simulation(VAS)score,the Ramsay score,and the values of the hemodynamics of the women before entry of the operative room(T0),at 10 min after anesthesia(T1),at delivery(T2),and after operation(T3)were compared.between the two groups.The blood gas analysis indexes of neonatal umbilical artery in the two groups were detected.Results:The incidence of chills(10.3%)of the women in the study group was significantly lower than that(25.0%).of the women in the control group(P<0.05).There was no significant difference in the VAS score of the women at T0 between the two groups(P>0.05).The VAS score of the women in the two groups at T1,T2,and T3 was signifi-cantly higher than that at T0.The VAS score which of the women in study groupat T1,T2,and T3 were 2.52±0.41.points,2.67±0.47 points,and 2.85±0.52 points,respectively,and which of the women were significantly lower than those(4.07±0.69 points,4.34±0.68 points,and 4.12±0.49 points,respectively)of the women in the control group(all P<0.05).There were no significant differences in the hemodynamics values of the women at T0 between the two groups(P>0.05).The values of diastolic blood pressure(DBP),systolic blood pressure(SBP),and heart rate(HR)of the women in the two groups at T1 were significantly lower than those at T0.The values of SBP and DBP of the women in the two groups and the HR value of the women in the control group at T2 were significantly lower than those at T0.The Ramsay score of the women in the two groups at T3 was significantly higher than that at T0.The values of HR and SBP of the women in the study group at T2 were significantly higher than those of the women in the control group.The DBP value of the women in the study groupat T1 and T2 was significantly higher than that of the women in the control group.The Ramsay score of the women in the study group at Tl,T2,and T3 was significantly higher than that of the women in the control group(all P<0.05).There were no significant differences in the values of the neonatal umbilical artery pH,partial pressure of carbon dioxide,the partial pressure of oxygen,and the rate of the nconatal Apgar score≤7 points between the two groups(P>0.05).Conclusion:Dextrmedetomidine nasal drip of the women during cesarcan section again can prevent their traction pain,reduce their incidence of chill during operation,stabilize their hemodynamics,and which has lttle impact on their neonates.