硬膜外使用右美托咪定與羅哌卡因復合液在二次剖宮產(chǎn)術(shù)中的應用

　　[摘要]目的 觀察硬膜外使用右美托咪定與羅哌卡因復合液在二次剖宮產(chǎn)術(shù)中的應用效果。方法 隨機選擇2015年12月～2016年12月于江蘇省婦幼保健院產(chǎn)科就診、擬行二次子宮下段剖宮產(chǎn)術(shù)、麻醉方式為連續(xù)硬膜外麻醉的40例單胎足月產(chǎn)婦，采用隨機數(shù)字表法分為D組（硬膜外應用0.5 μg/k g的右美托咪定2 ml與0.75%羅哌卡因15 ml的混合液）和R組（硬膜外應用0.75%的羅哌卡因15 ml與生理鹽水2 ml的復合液），每組20例。記錄兩組麻醉前（T0），硬膜外注藥完畢后10 min時（T1）、30 min時（T2）、和術(shù)畢（T3）4個時點的MAP和HR，比較兩組的硬膜外阻滯起效時間、最高平面、達最高平面時間及感覺阻滯時間，觀察兩組的T2時點改良Bromage分級、術(shù)中Ramsay鎮(zhèn)靜評分和牽拉反應程度，記錄兩組的胎兒娩出前使用瑞芬太尼的例數(shù)及產(chǎn)婦發(fā)生呼吸抑制和寒戰(zhàn)的例數(shù)。結(jié)扎臍帶后，自臍靜脈抽取血液1 ml留做血氣分析，記錄并比較新生兒1、5 min Apgar評分。結(jié)果 兩組產(chǎn)婦各時點的MAP、HR水平比較，差異無統(tǒng)計學意義（P>0.05）。D組患者的麻醉起效時間、阻滯平面達最高時間短于R組，感覺阻滯時間長于R組，差異有統(tǒng)計學意義（P<0.05）。D組產(chǎn)婦的鎮(zhèn)靜滿意度高于R組，術(shù)中牽拉反應輕于R組，使用瑞芬太尼所占比例低于R組，呼吸抑制發(fā)生率低于R組，差異有統(tǒng)計學意義（P<0.05）。D組新生兒出生后1 min時的Apgar評分高于R組，差異有統(tǒng)計學意義（P<0.05）。結(jié)論 與單獨使用羅哌卡因相比，硬膜外使用右美托咪定與羅哌卡因復合液可增強二次剖宮產(chǎn)術(shù)硬膜外麻醉效果，同時對產(chǎn)婦生命體征、新生兒內(nèi)環(huán)境無明顯影響。
　　[關(guān)鍵詞]右美托咪定；硬膜外麻醉；二次剖宮產(chǎn)術(shù)
　　[中圖分類號] R719.8 [文獻標識碼] A [文章編號] 1674-4721（2018）2（b）-0113-04
　　Application of epidural use of compound solution of Dexmedetomidine and Ropivacaine on patients undergoing repeated cesarean section
　　WU Xia1 YU Li1 JIANG Xiu-hong1 HE Ming-feng2
　　1.Department of Anesthesiology，Women and Children Health Care Hospital of Jiangsu Province，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210036，China；2.Department of Anesthesiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
　　[Abstract]Objective To observe the effect of epidural use of Dexmedetomidine and Ropivacaine on patients undergoing repeated cesarean section.Methods A total of 40 parturient，treated in Jiangsu Women and Children Health Care Hospital from December 2015 to December 2016，scheduled for repeated cesarean section under epidural anesthesia were selected randomly.According to the random number table method，the patients were divided into group D and group R，with 20 patients in each group.0.75% Ropivacaine 15 ml was administered epidurally，with addition of 0.5 μg/kg of Dexmedetomidine in group D，and 2 ml of normal saline in group R.Mean arterial pressure （MAP），heart rate （HR） before anesthesia （T0），at 10 min after administration of the specific drugs （T1），at 30 min after administration of the specific drugs （T2），and end of surgery （T3） were recorded.The onset time of epidural sensory block，maximum sensory analgesic level，the time to maximum sensory analgesic level，the time of sensory block were collected.The modified Bromage scale，Ramsay grade and grade of traction reaction at T2，cases who used remifentanil，incidence of respiration inhibition and shiver were also assessed.Blood from umbilical veins was collected for blood gas analysis.The Apgar scores were evaluated at 1 and 5 min.Results There was no significant difference in the MAP and HR at T0，T1，T2 and T3 between the two groups （P>0.05）.The onset time of epidural sensory block and the time to maximum sensory analgesic level in group D was shorter than that in group R，and the time of sensory block in group D was longer than that of group R，with significant difference （P<0.05）.The degree of sedative satisfaction in group D was higher than that in group R，the effect of traction reaction in the operation in group D was less than that of group R，and the proportion of the use of Remifentanil in group D was lower than that of group R，and the incidence of respiratory inhibition in group D was lower than that in group R，with significant difference （P<0.05）.The score of Apgar at 1 min after birth in group D was higher than that in group R，with significant difference （P<0.05）.Conclusion For patients undergoing repeated cesarean section，epidural use of Dexmedetomidine combined with Ropivacaine can enhance the anesthetic effect，without obvious adverse maternal or neonatal effects.

相關(guān)熱詞搜索：復合 卡因 剖宮產(chǎn) 硬膜外 右美托咪定