国际麻醉学与复苏杂志
國際痳醉學與複囌雜誌
국제마취학여복소잡지
INTERNATIONAL JOURNAL OF ANESTHESIOLOGY AND RESUSCITATION
2014年
6期
510-514
,共5页
李胜华%罗威%王长社%赵继蓉%吴娟%蔡徐山
李勝華%囉威%王長社%趙繼蓉%吳娟%蔡徐山
리성화%라위%왕장사%조계용%오연%채서산
右美托咪定%腰硬联合麻醉%剖宫产%临产妇%新生儿
右美託咪定%腰硬聯閤痳醉%剖宮產%臨產婦%新生兒
우미탁미정%요경연합마취%부궁산%임산부%신생인
Dexmedetomidine%Combined spinal-epidural anesthesia%Cesarean delivery%Parturient%Newborn
目的 探讨麻醉前静注右美托咪定(dexmedetomidine,Dex)对腰硬联合麻醉下剖宫产产妇与新生儿的影响.方法 选取美国麻醉医师协会(ASA)分级为Ⅰ或Ⅱ级、拟在腰硬联合麻醉下接受择期剖宫产的足月临产妇90例,使用随机数字表法将其随机分为3组,每组30例:A组静脉给予生理盐水;B组静脉给予Dex 0.5 μg/kg;C组静脉给予Dex 1 μg/kg.观察静脉输注试验药物前(T1)、输注开始后5(T2)、10(T3)、15(T4)、20 min(T5)及胎儿娩出时(T6)产妇的平均动脉压(mean artery perssure,MAP)、心率(heart rate,HR)、脉搏血氧饱和度(pulse oxygen saturation,SpO2)、Ramsay镇静评分;记录感觉阻滞起效时间、持续时间、最高平面及达到最高平面时间和运动阻滞起效时间、持续时间、最高评分及达到最高评分时间;胎儿娩出断脐后立刻抽取脐动脉血进行血气分析和乳酸测定,记录新生儿出生后1、5 min时Apgar评分;评价并记录出生后2、14 d时新生儿神经行为学(neonatal behaviral neurological assessment,NBNA)评分. 结果 C组患者T2～T6时Ramsay评分显著高于A组和B组,MAP、HR、SpO2显著低于A组和B组(P＜0.05).A组、B组、C组的感觉起效时间、持续时间、最高麻醉平面中位数(T)、达到最高平面的时间分别为(5.5±1.9) minvs (3.9±1.5) minvs (3.9±1.6) min、(80.1±13.4) min vs(92.0±14.5) min vs(91.3±15.5) min、T5(T6,T4)vs T4(T4,T3)vs T4(T4,T3)、(13.2±3.2) min vs (10.4±1.9) min vs(10.2±2.5) min,A组与B组、C组比较,差异均有统计学意义(P＜0.05).A组、B组、C组的运动起效时间、恢复时间、运动阻滞最高评分的时间为(4.2±1.7) min vs(3.3±1.4) min vs(3.1±1.2) min、(84.5±10.4) min vs (95.6±14.3) min vs (98.3-±12.3) min、(16.5±5.8) min vs (13.3-±2.7) min vs(12.4±2.7) min,A组与B组、C组比较,差异均有统计学意义(P＜0.05).3组之间新生儿脐动脉血气、乳酸值和出生1、5 min时Apgar评分以及出生后2、24 d时的NBNA评分差异无统计学意义(P＞0.05). 结论 腰硬联合麻醉前应用Dex可以产生良好的镇静作用,缩短腰硬联合麻醉起效时间、延长持续时间,且对新生儿Apgar评分和NBNA评分无副作用;其中0.5 μg/kg Dex对产妇血流动力学影响小于1 μg/kg.
目的 探討痳醉前靜註右美託咪定(dexmedetomidine,Dex)對腰硬聯閤痳醉下剖宮產產婦與新生兒的影響.方法 選取美國痳醉醫師協會(ASA)分級為Ⅰ或Ⅱ級、擬在腰硬聯閤痳醉下接受擇期剖宮產的足月臨產婦90例,使用隨機數字錶法將其隨機分為3組,每組30例:A組靜脈給予生理鹽水;B組靜脈給予Dex 0.5 μg/kg;C組靜脈給予Dex 1 μg/kg.觀察靜脈輸註試驗藥物前(T1)、輸註開始後5(T2)、10(T3)、15(T4)、20 min(T5)及胎兒娩齣時(T6)產婦的平均動脈壓(mean artery perssure,MAP)、心率(heart rate,HR)、脈搏血氧飽和度(pulse oxygen saturation,SpO2)、Ramsay鎮靜評分;記錄感覺阻滯起效時間、持續時間、最高平麵及達到最高平麵時間和運動阻滯起效時間、持續時間、最高評分及達到最高評分時間;胎兒娩齣斷臍後立刻抽取臍動脈血進行血氣分析和乳痠測定,記錄新生兒齣生後1、5 min時Apgar評分;評價併記錄齣生後2、14 d時新生兒神經行為學(neonatal behaviral neurological assessment,NBNA)評分. 結果 C組患者T2～T6時Ramsay評分顯著高于A組和B組,MAP、HR、SpO2顯著低于A組和B組(P＜0.05).A組、B組、C組的感覺起效時間、持續時間、最高痳醉平麵中位數(T)、達到最高平麵的時間分彆為(5.5±1.9) minvs (3.9±1.5) minvs (3.9±1.6) min、(80.1±13.4) min vs(92.0±14.5) min vs(91.3±15.5) min、T5(T6,T4)vs T4(T4,T3)vs T4(T4,T3)、(13.2±3.2) min vs (10.4±1.9) min vs(10.2±2.5) min,A組與B組、C組比較,差異均有統計學意義(P＜0.05).A組、B組、C組的運動起效時間、恢複時間、運動阻滯最高評分的時間為(4.2±1.7) min vs(3.3±1.4) min vs(3.1±1.2) min、(84.5±10.4) min vs (95.6±14.3) min vs (98.3-±12.3) min、(16.5±5.8) min vs (13.3-±2.7) min vs(12.4±2.7) min,A組與B組、C組比較,差異均有統計學意義(P＜0.05).3組之間新生兒臍動脈血氣、乳痠值和齣生1、5 min時Apgar評分以及齣生後2、24 d時的NBNA評分差異無統計學意義(P＞0.05). 結論 腰硬聯閤痳醉前應用Dex可以產生良好的鎮靜作用,縮短腰硬聯閤痳醉起效時間、延長持續時間,且對新生兒Apgar評分和NBNA評分無副作用;其中0.5 μg/kg Dex對產婦血流動力學影響小于1 μg/kg.
목적 탐토마취전정주우미탁미정(dexmedetomidine,Dex)대요경연합마취하부궁산산부여신생인적영향.방법 선취미국마취의사협회(ASA)분급위Ⅰ혹Ⅱ급、의재요경연합마취하접수택기부궁산적족월임산부90례,사용수궤수자표법장기수궤분위3조,매조30례:A조정맥급여생리염수;B조정맥급여Dex 0.5 μg/kg;C조정맥급여Dex 1 μg/kg.관찰정맥수주시험약물전(T1)、수주개시후5(T2)、10(T3)、15(T4)、20 min(T5)급태인면출시(T6)산부적평균동맥압(mean artery perssure,MAP)、심솔(heart rate,HR)、맥박혈양포화도(pulse oxygen saturation,SpO2)、Ramsay진정평분;기록감각조체기효시간、지속시간、최고평면급체도최고평면시간화운동조체기효시간、지속시간、최고평분급체도최고평분시간;태인면출단제후립각추취제동맥혈진행혈기분석화유산측정,기록신생인출생후1、5 min시Apgar평분;평개병기록출생후2、14 d시신생인신경행위학(neonatal behaviral neurological assessment,NBNA)평분. 결과 C조환자T2～T6시Ramsay평분현저고우A조화B조,MAP、HR、SpO2현저저우A조화B조(P＜0.05).A조、B조、C조적감각기효시간、지속시간、최고마취평면중위수(T)、체도최고평면적시간분별위(5.5±1.9) minvs (3.9±1.5) minvs (3.9±1.6) min、(80.1±13.4) min vs(92.0±14.5) min vs(91.3±15.5) min、T5(T6,T4)vs T4(T4,T3)vs T4(T4,T3)、(13.2±3.2) min vs (10.4±1.9) min vs(10.2±2.5) min,A조여B조、C조비교,차이균유통계학의의(P＜0.05).A조、B조、C조적운동기효시간、회복시간、운동조체최고평분적시간위(4.2±1.7) min vs(3.3±1.4) min vs(3.1±1.2) min、(84.5±10.4) min vs (95.6±14.3) min vs (98.3-±12.3) min、(16.5±5.8) min vs (13.3-±2.7) min vs(12.4±2.7) min,A조여B조、C조비교,차이균유통계학의의(P＜0.05).3조지간신생인제동맥혈기、유산치화출생1、5 min시Apgar평분이급출생후2、24 d시적NBNA평분차이무통계학의의(P＞0.05). 결론 요경연합마취전응용Dex가이산생량호적진정작용,축단요경연합마취기효시간、연장지속시간,차대신생인Apgar평분화NBNA평분무부작용;기중0.5 μg/kg Dex대산부혈류동역학영향소우1 μg/kg.
Objective To investigate the effects of dexmedetomidine (Dex) on cesarean delivery women and newborn undergoing combined spinal-epidural anesthesia.Methods Ninety ASA Ⅰ-Ⅱ full-term pregnancy women who underwent elective cesarean section were randomly divided into 3 groups(n=30):control group (group A) and Dex group (group B and group C).Dex was respectively infused intravenously at 0.5 μg/kg in group B and 1 μg/kg in group C while in group A equal volume of normal saline was infused instead of Dex.The maternal mean arterial pressure (MAP),heart rate (HR),pulse oxygen saturation(SpO2),Ramsay scores of mothers were recorded at six time points:before iv(T1),5 min after iv(T2),10 min after iv(T3),15 min after iv (T4),20 min after iv (T5) and the neonate was delivered (T6).Sensory block onset time,duration,the highest level,the time required to achieve the highest level were also recorded,as well as motor block onset time,the highest scores,the time required to achieve the highest scores.Umbilical arterial blood was obtained immediately after breaking the umbilical cord for analysis of blood gas and lactic acid.Apgar scores 1 min and 5 min after labor were recorded,and neonatal behavioral neurological assessment (NBNA) scores 2 d and 14 d after labor were evaluated.Results Ramsay scores were significantly higher,MAP,HR,SpO2 were lower in group C than in group A and B(P＜0.05).Sensory block onset time,duration,the highest level median,the time required to achieve the highest level of group A,group B,group C were respectively as follows:(5.5±1.9) min vs (3.9±1.5) min vs (3.9±1.6) min,(80.1±13.4) min vs (92.0±14.5) min vs (91.3±15.5) min,5.5 (6,4) vs 4 (4,3) vs 4 (4,3),(13.2±3.2) min vs (10.4±1.9) min vs (10.2±2.5) min.The differences were statistically significant (P＜O.05) compared with group A.Motor block o nset time,the highest scores,the time required to achieve the highest scores of group A,group B,group C were respectively as follows:(4.2±1.7) min vs (3.3±1.4) min vs (3.1±1.2) min,(84.5±10.4) min vs (95.6±14.3) min vs (98.3±12.3) min,(16.5±5.8) min vs (13.3±2.7) min vs (12.4±2.7) min.The differences were statistically significant compare with group A(P＜0.05).There was no significant differences in umbilical arterial blood gas analysis,lactic acid,Apgar Scores and NBNA scores among the 3 groups (P＞0.05).Conclusions Dex can provide good sedation,shorten onset time of spinal anesthesia and extend the blocking duration with no adverse effects on Apgar scores and NBNA scores before employing combined spinal-epidural anesthesia.The effect on maternal hemodynamics was less at 0.5 μg/kg than 1 μg/kg of Dex.
