徐嘉莹;张砡;张秀华;付晨薇;刘俊涛;黄宇光;
XU Jia-ying;ZHANG Yu;ZHANG Xiu-hua;FU Chen-wei;LIU Jun-tao;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

• 1:中国医学科学院北京协和医学院北京协和医院麻醉科
• 2:中国医学科学院北京协和医学院北京协和医院妇产科

摘要(Abstract)：

目的观察静脉右美托咪定用于腰硬联合麻醉下剖宫产术的镇静效果和对术中不良反应的影响。方法选择单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇50名,随机数字表法分为右美托咪定组(研究组,25名)和生理盐水组(对照组,25名)。蛛网膜下腔穿刺成功后,给予重比重0.5%布比卡因8 mg,胎儿娩出后,研究组予右美托咪定负荷剂量1μg/kg静脉泵注,10 min输完后改为0.5μg/(kg·h)静脉泵注,对照组予等量生理盐水静脉泵注,直至术毕。术中每30 min记录产妇的Ramsay镇静评分,记录术中不良反应和药物副作用发生率,并记录新生儿出生1、5 min的Apgar评分。结果研究组的Ramsay镇静评分显著高于对照组(3.4±0.7比2.2±0.4,P=0.001)。对于术中不良反应,研究组寒战(0比16%,P=0.001)、恶心呕吐(8%比36%,P=0.019)、手术牵拉导致的腹部不适发生率(12%比48%,P=0.006)均显著低于对照组。对于药物副作用,研究组心动过缓发生率显著高于对照组(24%比0,P=0.011),而两组低血压、过度镇静和呼吸抑制发生率差异无统计学意义。两组新生儿Apgar评分差异亦无统计学意义。结论静脉右美托咪定可为行腰硬联合麻醉下剖宫产术的产妇提供良好镇静效果,增加其术中安静合作程度,降低术中不良反应的发生率,同时药物副作用较小,对新生儿无不良影响。
Objective To evaluate the effect of intravenous dexmedetomidine on intraoperative sedation and adverse events in parturients undergoing Cesarean section using combined spinal-epidural anesthesia.Methods Fifty singleton parturients at term scheduled for Cesarean section under combined spinal-epidural anesthesia were allocated to two groups using random numbers: dexmedetomidine group( study group,n = 25) and normal saline group( control group,n = 25). All the parturients received 0. 5% hyperbaric bupivacaine 8 mg intrathecally following subarachnoid puncture. After delivery of the baby,the study group received dexmedetomidine1 μg / kg intravenous bolus infusion for 10 minutes followed by 0. 5 μg /( kg·h) continuous infusion until the end of surgery,whereas the control group was infused with equivalent amount of normal saline. Ramsay scores were recorded every 30 minutes during the surgery. The incidence of intraoperative adverse events and adverse drug reactions were also recorded,as well as 1-minute and 5-minute Apgar scores of the newborns. Results Ramsay score of the study group was significantly higher than that of the control group( 3. 4 ± 0. 7 vs. 2. 2 ± 0. 4,P = 0. 001). Incidences of shivering( 0 vs. 16%,P = 0. 001),nausea and vomiting( 8% vs. 36%,P = 0. 019),abdominal dis-comfort upon surgical traction( 12% vs. 48%,P = 0. 006) in the study group were all significantly lower than those in the control group. In terms of adverse drug reactions,incidence of bradycardia in the study group was higher than that in the control group( 24% vs. 0,P = 0. 011),while incidences of hypotension,oversedation,and respiratory depression showed no significant difference between the two groups. Apgar scores of the two groups also showed no significant difference. Conclusions Intravenous dexmedetomidine could improve intraoperative sedative effect in parturients undergoing Cesarean section under combined spinal-epidural anesthesia and reduce the incidence of intraoperative adverse events with little adverse reaction and no influence on neonates.

关键词(KeyWords)： 右美托咪定;剖宫产术;麻醉;镇静
dexmedetomidine;Cesarean section;anesthesia;sedation

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 徐嘉莹;张砡;张秀华;付晨薇;刘俊涛;黄宇光;
XU Jia-ying;ZHANG Yu;ZHANG Xiu-hua;FU Chen-wei;LIU Jun-tao;HUANG Yu-guang;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;Department of Obstetrics and Gynecology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences & Peking Union Medical College;

Email:

DOI:

参考文献(References)：

• [1]Gizzo S,Noventa M,Fagherazzi S,et al.Update on best available options in obstetrics anesthesia:perinatal outcomes,side effects and maternal satisfaction:fifteen years systematic literature review[J].Arch Gynecol Obstet,2014,290:21-34.
• [2]Kim JM,Kim WO,Kim HB,et al.Adequate sedation with single-dose dexmedetomidine in patients undergoing transurethral resection of the prostate with spinal anesthesia:a doseresponse study by age group[J].BMC Anesthesiol,2015,27;15-17.
• [3]Basar H,Akpinar S,Doganci N,et al.The effects of preanesthetic,single-dose dexmedetomidine on induction,hemodynamic,and cardiovascular parameters[J].J Clin Anesth,2008,20:431-436.
• [4]Peden CJ,Cloote AH,Stratford N,et al.The effect of intravenous dexmedetomidine premedication on the dose requirement of propofol to induce loss of consciousness in patients receiving alfentanil[J].Anaesthesia,2001,56:408-413.
• [5]Esmaoglu A,Yegenoglu F,Akin A,et al.Dexmedetomidine added to levobupivacaine prolongs axillary brachial plexus block[J].Anesth Analg,2010,111:1548-1551.
• [6]Faraj W,Abdallah AA,Brull R.The facilitatory effects of intravenous dexmedetomidine on the duration of spinal anesthesia:a systematic review and meta-analysis[J].Anesth Analg,2013,117:271-278.
• [7]Keating GM.Dexmedetomidine:a review of its use for sedation in the intensive care setting[J].Drugs,2015,75:1119-1130.
• [8]Adams R,Brown GT,Davidson M,et al.Efficacy of dexmedetomidine compared with midazolam for sedation in adult intensive care patients:a systematic review[J].Br J Anaesth,2013,111:703-710.
• [9]Nie Y,Liu Y,Luo Q,et al.Effect of dexmedetomidine combined with sufentanil for post-caesarean section intravenous analgesia:a randomised,placebo-controlled study[J].Eur J Anaesthesiol,2014,31:197-203.
• [10]Ickeringill M,Shehabi Y,Adamson H,et al.Dexmedetomidine infusion without loading dose in surgical patient requiring mechanical ventilation:haemodynamic effect and efficacy[J].Anaesth Intensive Care,2004,32:741-745.
• [11]Bajwa SJ,Gupta S,Kaur J,et al.Reduction in the incidence of shivering with perioperative dexmedetomidine:a randomized prospective study[J].J Anaesthesiol Clin Pharmacol,2012,28:86-91.
• [12]Yu M,Han C,Jiang X,et al.Effect and placental transfer of dexmedetomidine during caesarean section under general anesthesia[J].Basic Clin Pharmacol Toxicol,2015,117:201-208.
• [13]Yousef AA,Salem HA,Moustafa MZ.Effect of mini-dose epidural dexmedetomidine in elective cesarean section using combined spinal-epidural anesthesia:a randomized doubleblinded controlled study[J].J Anesth,2015,29:708-714.