CAJ | 학술논문

目的：探讨剖宫产手术麻醉中使用右美托咪定的镇静效果以及对新生儿的Apgar评分的影响。方法选择广东省云浮市人民医院腰硬联合麻醉行剖宫产手术的孕妇240例，将其随机分为四组，每组60例，右美托咪定三组(A、B、C组)；生理盐水对照组(D组)。麻醉操作前A、B、C三组分别开始以微泵持续泵入右美托咪定0.6、0.8、1μg/kg，时间设定为15 min；D组注射相同剂量的生理盐水，四组孕妇均于L3~L4间隙行腰硬联合麻醉，于注药前(T0)、注药后10 min(T1)、注药后20 min(T2)、注药后30 min(T3)对孕妇进行Ramsay镇静水平评分，于T0和T2进行焦虑视觉类比试验(AVAT)和状态焦虑问卷测试(SAI)并记录，连续监测HR、SpO2、MAP，并记录T0、T1、T2、T3时的测定值，比较各组新生儿1、5、10 min的Apgar评分。结果 A、B、C三组孕妇T2时AVAT值[(23.7±11.8)、(22.1±12.3)、(23.5±11.7)]明显低于T0[(39.8±17.1)、(42.5±18.3)、(40.7±17.7)]，差异均有统计学意义(P<0.05)；A、B、C三组孕妇T2时SAI值[(33.6±6.8)、(31.1±6.5)、(30.4±6.7)]明显低于T0[(41.3±7.5)、(42.2±8.1)、(42.4±7.6)]，差异均有统计学意义(P<0.05)；A、B、C三组T1、T2时Ramsay评分[A组：(2.6±0.2)、(2.8±0.3)分；B组：(3.4±0.5)、(3.5±0.8)分；C组：(3.5±0.8)、(4.7±0.6)分]明显高于T0[(1.5±0.5)、(1.6±0.5)、(1.5±0.5)分]，差异均有统计学意义(P<0.05)；与A、B、C三组T2时的HR较T0时明显下降(P<0.05)；A组的MAP在T0~T2时段平稳，而T2时B、C两组的MAP较T0明显降低，D组T1和T2时的MAP、HR与T0时比较，MAP明显下降，心率明显增快，差异均有统计学意义(P<0.05)，四组孕妇的新生儿出生后1、5、10 min时的Apgar评分组间比较差异无统计学意义(P>0.05)。结论剖宫产手术麻醉中使用右美托咪定能对孕妇产生镇静效应，对新生儿Apgar评分无影响，且使用0.6μg/kg剂量的右美托咪定的孕妇镇静水平适当，血流动力学最为稳定，值得推荐使用。目的：探討剖宮產手術痳醉中使用右美託咪定的鎮靜效果以及對新生兒的Apgar評分的影響。方法選擇廣東省雲浮市人民醫院腰硬聯閤痳醉行剖宮產手術的孕婦240例，將其隨機分為四組，每組60例，右美託咪定三組(A、B、C組)；生理鹽水對照組(D組)。痳醉操作前A、B、C三組分彆開始以微泵持續泵入右美託咪定0.6、0.8、1μg/kg，時間設定為15 min；D組註射相同劑量的生理鹽水，四組孕婦均于L3~L4間隙行腰硬聯閤痳醉，于註藥前(T0)、註藥後10 min(T1)、註藥後20 min(T2)、註藥後30 min(T3)對孕婦進行Ramsay鎮靜水平評分，于T0和T2進行焦慮視覺類比試驗(AVAT)和狀態焦慮問捲測試(SAI)併記錄，連續鑑測HR、SpO2、MAP，併記錄T0、T1、T2、T3時的測定值，比較各組新生兒1、5、10 min的Apgar評分。結果 A、B、C三組孕婦T2時AVAT值[(23.7±11.8)、(22.1±12.3)、(23.5±11.7)]明顯低于T0[(39.8±17.1)、(42.5±18.3)、(40.7±17.7)]，差異均有統計學意義(P<0.05)；A、B、C三組孕婦T2時SAI值[(33.6±6.8)、(31.1±6.5)、(30.4±6.7)]明顯低于T0[(41.3±7.5)、(42.2±8.1)、(42.4±7.6)]，差異均有統計學意義(P<0.05)；A、B、C三組T1、T2時Ramsay評分[A組：(2.6±0.2)、(2.8±0.3)分；B組：(3.4±0.5)、(3.5±0.8)分；C組：(3.5±0.8)、(4.7±0.6)分]明顯高于T0[(1.5±0.5)、(1.6±0.5)、(1.5±0.5)分]，差異均有統計學意義(P<0.05)；與A、B、C三組T2時的HR較T0時明顯下降(P<0.05)；A組的MAP在T0~T2時段平穩，而T2時B、C兩組的MAP較T0明顯降低，D組T1和T2時的MAP、HR與T0時比較，MAP明顯下降，心率明顯增快，差異均有統計學意義(P<0.05)，四組孕婦的新生兒齣生後1、5、10 min時的Apgar評分組間比較差異無統計學意義(P>0.05)。結論剖宮產手術痳醉中使用右美託咪定能對孕婦產生鎮靜效應，對新生兒Apgar評分無影響，且使用0.6μg/kg劑量的右美託咪定的孕婦鎮靜水平適噹，血流動力學最為穩定，值得推薦使用。
목적：탐토부궁산수술마취중사용우미탁미정적진정효과이급대신생인적Apgar평분적영향。방법선택광동성운부시인민의원요경연합마취행부궁산수술적잉부240례，장기수궤분위사조，매조60례，우미탁미정삼조(A、B、C조)；생리염수대조조(D조)。마취조작전A、B、C삼조분별개시이미빙지속빙입우미탁미정0.6、0.8、1μg/kg，시간설정위15 min；D조주사상동제량적생리염수，사조잉부균우L3~L4간극행요경연합마취，우주약전(T0)、주약후10 min(T1)、주약후20 min(T2)、주약후30 min(T3)대잉부진행Ramsay진정수평평분，우T0화T2진행초필시각류비시험(AVAT)화상태초필문권측시(SAI)병기록，련속감측HR、SpO2、MAP，병기록T0、T1、T2、T3시적측정치，비교각조신생인1、5、10 min적Apgar평분。결과 A、B、C삼조잉부T2시AVAT치[(23.7±11.8)、(22.1±12.3)、(23.5±11.7)]명현저우T0[(39.8±17.1)、(42.5±18.3)、(40.7±17.7)]，차이균유통계학의의(P<0.05)；A、B、C삼조잉부T2시SAI치[(33.6±6.8)、(31.1±6.5)、(30.4±6.7)]명현저우T0[(41.3±7.5)、(42.2±8.1)、(42.4±7.6)]，차이균유통계학의의(P<0.05)；A、B、C삼조T1、T2시Ramsay평분[A조：(2.6±0.2)、(2.8±0.3)분；B조：(3.4±0.5)、(3.5±0.8)분；C조：(3.5±0.8)、(4.7±0.6)분]명현고우T0[(1.5±0.5)、(1.6±0.5)、(1.5±0.5)분]，차이균유통계학의의(P<0.05)；여A、B、C삼조T2시적HR교T0시명현하강(P<0.05)；A조적MAP재T0~T2시단평은，이T2시B、C량조적MAP교T0명현강저，D조T1화T2시적MAP、HR여T0시비교，MAP명현하강，심솔명현증쾌，차이균유통계학의의(P<0.05)，사조잉부적신생인출생후1、5、10 min시적Apgar평분조간비교차이무통계학의의(P>0.05)。결론부궁산수술마취중사용우미탁미정능대잉부산생진정효응，대신생인Apgar평분무영향，차사용0.6μg/kg제량적우미탁미정적잉부진정수평괄당，혈류동역학최위은정，치득추천사용。
Objective To investigate the sedative effect of Dexmedetomidine in cesarean section and affect the new-born's Apgar score. Methods 240 cases of pregnant women with caesarean section under combined spinal-epidural anesthesia in the People's Hospital of Yunfu City were selected, they were randomly divided into four groups, with 60 cases in each group, three Dexmedetomidine groups (group A, B, C); saline control group (group D), before anesthesia groups A, B, C were given the 0.6, 0.8, 1 μg/kg Dexmedetomidine micropump continuous infusion respectively, time was set for 15 minutes; group D were injected with the same dose of saline, pregnant women of four groups were given the epidural anesthesia injection at L3-L4 interspace. Pregnant women were given Ramsay sedation level score before injection (T0) recorded 10 min after injection (T1), 20 min after injection (T2) , 30 min after injection (T3); and the anxi-ety visual analog test (AVAT); state anxiety inventory test (SAI) were carried out and recorded at T0, T2; continuous monitoring of HR, SpO2, MAP and the value at T0, T1, T2, T3 were recorded. The newborn Apgar score at 1, 5 min and 10 min after birth of four groups were compared. Results AVAT value of group A, B, C at T2 [(23.7±11.8), (22.1±12.3), (23.5±11.7)] were significantly lower than T0 [(39.8±17.1), (42.5±18.3), (40.7±17.7)], the differences were statistically significant (P<0.05);SAI value of group A, B, C at T2 [(33.6±6.8), (31.1±6.5), (30.4±6.7)] were significantly lower than T0 [(41.3±7.5), (42.2±8.1), (42.4±7.6)], the differences were statistically significant (P<0.05);Ramsay score of group A, B, C at T1, T2 [group A: (2.6±0.2), (2.8±0.3) points;group B: (3.4±0.5), (3.5±0.8) points; group C: (3.5±0.8), (4.7±0.6) points] were significantly higher than T0 [(1.5±0.5), (1.6±0.5), (1.5±0.5) points], the differences were statisti-cally significant (P<0.05);compared with T2, the HR of group A, B, C at T0 were decreased significantly (P<0.05);MAP of group A at T0, T2 were stable, while group B, C at T2 were significantly lower than T0, compared with T0, MAP and HR of group D at T1 and T2 were decreased significantly, heart rate were significantly increased, and the differences were statistically significant (P<0.05). The newborn Apgar score at 1, 5 min and 10 min after birth in four groups had no statistically significant difference (P>0.05). Conclusion Cesarean section anesthesia using dexmedetomidine capital in pregnant women can produce sedative effect, no effect on the Apgar score, and 0.6 μg/kg dose dexmedetomidine se-dation given the appropriate level of maternal blood most stable hemodynamics, it is recommended to use.