右美托咪定不同时机给药对腰-硬联合麻醉后剖宫产产妇寒战反应的影响

摘要

目的 比较右美托咪定不同时机给药对腰-硬联合麻醉后剖宫产产妇寒战反应的影响.方法 腰-硬联合麻醉下行剖宫产产妇120例,随机分为三组,每组40例.A组与B组分别在麻醉开始前15 min、胎儿娩出即刻静脉泵注右美托咪定0.4μg/kg(15 min);C组为对照组,静脉泵注等容量生理盐水.记录产妇寒战发生时间及等级,产妇Ramsay镇静程度评分以及恶心、呕吐、牵拉反应等不良反应发生情况.结果至术毕30 min,A组发现寒战2例(5.0%)、牵拉反应2例(5.0%),B组发现寒战8例(20.0%)、牵拉反应3例(7.5%),C组发现寒战19例(47.5%)、牵拉反应10例(25.0%).与C组比较,A、B两组产妇寒战发生率明显降低,寒战程度明显减轻(P<0.05),牵拉反应明显减少(P<0.05).与B组比较,A组产妇寒战发生率更低(P<0.05),寒战程度也更低(P<0.05);牵拉反应发生率差异无统计学意义.结论 腰-硬联合麻醉前给予右美托咪定预防剖宫产产妇寒战的效果优于胎儿娩出后给药.%Objective To compare the effect of two different time for intravenous dexmedeto-midine alleviates shivering during parturients cesarean undercombined spinal-epidural anaesthesia. Methods One hundred and twenty parturients delivery under combined spinal-epidural anaesthesiawere equally randomized into three groups.The parturients were intravenously injected with dexmedetomidine 0.4 μg/kg (15 min)at 15 min before the beginning of anesthesia (group A)or the time immediately after delivery of fetus (group B)respectively.Moreover,group C was the control group.Parturientsin group C were given equal volume of normal saline.Mean arterial pressure (MAP),heart rate(HR),pulse oxygen saturation (SpO 2 )and ear temperature were recorded respec-tively.Apgar scores of the fetus at 1 min and 5 min,the incidence and grade of shivering response, Ramsay sedative grade and adverse responses such as nausea,vomiting and traction reaction were re-corded as well.Results By 30 min after operation,2 parturients (5%)in group A,8 parturients (20%)in group B and 19 parturients (47.5%)in group C experienced shivering.Traction reaction was observed in 2 parturients (5%)in group A,in 3 parturients (7.5%)in group B and in 10 parturi-ents (25%)in group C respectively.Compared with group C,the incidence rate and degree of shive-ring were significantly lower in groups of A and B (P <0.05),as well as the traction reaction (P <0.05).The incidence rate and degree of shivering in group A were significantly lower than that in group B (P <0.05),but the incidence rates of traction reaction were not statistically different between the two groups.Conclusion Dexmedetomidine administered before combined spina-epidural anesthesia could prevented shivering response in parturients undergoing cesarean section better than being injected immediately after the birth offetus.