右美托咪定对孕产妇椎管内麻醉期间寒战及血流动力学的影响

Effect of dexmedetomidine on shivering and hemodynamics during spinal anesthesia in pregnant and postpartum women

目的 探讨右美托咪定对孕产妇行椎管内麻醉期间寒战及血流动力学的影响。方法 纳入384例术中发生寒战的剖宫产产妇并随机分为观察组和对照组,各192例。对照组采用哌替啶对寒战进行治疗,观察组采用右美托咪定。比较2组麻醉效果、寒战治疗的疗效、血流动力学指标及血清中超敏C反应蛋白(hs-CRP)、前列腺素E2(PGE2)、皮质醇(Cor)水平。结果 相较于对照组,观察组的寒战停止时间较短,寒战控制情况较好(P<0.05);2组舒张压、收缩压、心率、血氧饱和度均发生改变,但观察组波动幅度显著小于对照组(P<0.05);2组应激指标均升高,但观察组hs-CRP、PGE2、Cor水平较对照组升高幅度小(P<0.05);观察组不良反应总发生率低于对照组(P<0.05)。结论 临床应用右美托咪定对剖宫产产妇进行椎管内麻醉治疗寒战的效果较好,可稳定机体血流动力学水平,临床应用价值较高。

Objective To explore the effect of dexmedetomidine on shivering and hemodynamics during spinal anesthesia in pregnant and postpartum women.Methods A total of 384 cases of cesarean section women with shivering during operation admitted to the Fifth Affiliated Hospital of Guangzhou Medical University were selected as the study subjects and randomly divided into the observation group(n=192)and the control group(n=192).The control group was treated with pethidine for chills,while the observation group was treated with dexmedetomidine.For the anesthesia effect,occurrence of chills,the therapeutic effect of shivering treatment,hemodynamic indicators and serum levels of hypersensitive C-reactive protein(hs-CRP),prostaglandin E2(PGE2)and cortisol(Cor)were compared between two groups.Results Compared to the control group,the observation group had a shorter stopping time for shivering and better control of shivering(P<0.05).Both groups showed changes in hemodynamic indicators such as diastolic blood pressure(DBP),systolic blood pressure(SBP),heart rate(HR)and oxygen saturation(SpO2),but the fluctuation amplitude of the observation group was significantly smaller than that of the control group(P<0.05).Stress indicators increased in both groups(P<0.05),but levels of hs-CRP,PGE2 and Cor showed a smaller increase in the observation group compared to those of the control group(P<0.05).The total incidence of adverse reactions was lower in the observation group than that in the control group(P<0.05).Conclusion The clinical application of dexmedetomidine for spinal anesthesia has a good effect in the treatment of shivering in cesarean section women,which can stabilize the hemodynamic level of body and has high clinical application value.