中华医学杂志
中華醫學雜誌
중화의학잡지
National Medical Journal of China
2014年
44期
3501-3505
,共5页
韩传宝%蒋秀红%吴霞%丁正年
韓傳寶%蔣秀紅%吳霞%丁正年
한전보%장수홍%오하%정정년
右美托咪啶%麻醉,硬膜外%剖宫产术
右美託咪啶%痳醉,硬膜外%剖宮產術
우미탁미정%마취,경막외%부궁산술
Dexmedetomidine%Anesthesia,epidural%Cesarean section
目的:评价右美托咪啶复合罗哌卡因用于剖宫产硬膜外麻醉中的效果和对新生儿的影响。方法选择2012年1月至2013年3月南京医科大学第一附属医院单胎足月妊娠拟在硬膜外麻醉下行子宫下段剖宫产术的患者60例。采用随机数字表法,将患者分为右美托咪啶复合罗哌卡因组( RD组)、芬太尼复合罗哌卡因组( RF组)和生理盐水复合罗哌卡因组( RN组),每组20例。硬膜外穿刺成功并排除脊麻后,RD组给予0.75%罗哌卡因15 ml复合右美托咪啶1μg/kg,RF组给予0.75%罗哌卡因15 ml复合芬太尼1μg/kg,RN组给予0.75%罗哌卡因15 ml复合0.9%生理盐水2 ml。记录麻醉前(T0)、硬膜外注药完毕后10 min(T1)、30 min(T2)和术毕(T3)4个时点的平均动脉压( MAP)和心率( HR)。记录硬膜外阻滞起效时间、最高平面及达最高平面的时间,记录硬膜外阻滞持续时间和感觉阻滞时间。记录患者的Bromage分级和Ramsay镇静评分,记录术中牵拉反应程度。胎儿娩出后,抽取脐静脉血进行血气分析,并记录新生儿1、5 min时的Apgar评分。结果3组患者各时点间MAP、HR和Bromage分级比较差异无统计学意义(P>0.05)。与RN组比较,RD组和RF组的起效时间、达最高阻滞平面时间缩短[(6.3±2.4)、(8.7±2.3) min 比(10.9±2.7) min,(11.5±3.9)、(16.2±4.6) min 比(19.8±5.2) min,P<0.05],阻滞持续时间、感觉阻滞时间延长[(22.5±4.6)、(18.5±3.9)min 比(13.5±3.8)min,(415±92)、(355±86)min 比(273±68)min, P<0.05],最高阻滞平面高,镇静程度高,术中牵拉反应轻,RD组寒战的发生率低(5%比40%,P<0.05),RF组头晕的发生率高(20%比0%,P<0.05)。与RF组比较,RD组的起效时间、达最高阻滞平面时间缩短,阻滞持续时间、感觉阻滞时间延长,安静合作程度高,嗜睡发生率低。3组脐静脉血气分析、新生儿出生后1 min和5 min时的Apgar评分的比较差异均无统计学意义(均P>0.05)。结论罗哌卡因复合右美托咪啶可缩短硬膜外麻醉起效时间、延长感觉阻滞时间、增加术中产妇安静合作程度、降低术中牵拉反应和抑制寒战的发生,而对新生儿没有不良影响。
目的:評價右美託咪啶複閤囉哌卡因用于剖宮產硬膜外痳醉中的效果和對新生兒的影響。方法選擇2012年1月至2013年3月南京醫科大學第一附屬醫院單胎足月妊娠擬在硬膜外痳醉下行子宮下段剖宮產術的患者60例。採用隨機數字錶法,將患者分為右美託咪啶複閤囉哌卡因組( RD組)、芬太尼複閤囉哌卡因組( RF組)和生理鹽水複閤囉哌卡因組( RN組),每組20例。硬膜外穿刺成功併排除脊痳後,RD組給予0.75%囉哌卡因15 ml複閤右美託咪啶1μg/kg,RF組給予0.75%囉哌卡因15 ml複閤芬太尼1μg/kg,RN組給予0.75%囉哌卡因15 ml複閤0.9%生理鹽水2 ml。記錄痳醉前(T0)、硬膜外註藥完畢後10 min(T1)、30 min(T2)和術畢(T3)4箇時點的平均動脈壓( MAP)和心率( HR)。記錄硬膜外阻滯起效時間、最高平麵及達最高平麵的時間,記錄硬膜外阻滯持續時間和感覺阻滯時間。記錄患者的Bromage分級和Ramsay鎮靜評分,記錄術中牽拉反應程度。胎兒娩齣後,抽取臍靜脈血進行血氣分析,併記錄新生兒1、5 min時的Apgar評分。結果3組患者各時點間MAP、HR和Bromage分級比較差異無統計學意義(P>0.05)。與RN組比較,RD組和RF組的起效時間、達最高阻滯平麵時間縮短[(6.3±2.4)、(8.7±2.3) min 比(10.9±2.7) min,(11.5±3.9)、(16.2±4.6) min 比(19.8±5.2) min,P<0.05],阻滯持續時間、感覺阻滯時間延長[(22.5±4.6)、(18.5±3.9)min 比(13.5±3.8)min,(415±92)、(355±86)min 比(273±68)min, P<0.05],最高阻滯平麵高,鎮靜程度高,術中牽拉反應輕,RD組寒戰的髮生率低(5%比40%,P<0.05),RF組頭暈的髮生率高(20%比0%,P<0.05)。與RF組比較,RD組的起效時間、達最高阻滯平麵時間縮短,阻滯持續時間、感覺阻滯時間延長,安靜閤作程度高,嗜睡髮生率低。3組臍靜脈血氣分析、新生兒齣生後1 min和5 min時的Apgar評分的比較差異均無統計學意義(均P>0.05)。結論囉哌卡因複閤右美託咪啶可縮短硬膜外痳醉起效時間、延長感覺阻滯時間、增加術中產婦安靜閤作程度、降低術中牽拉反應和抑製寒戰的髮生,而對新生兒沒有不良影響。
목적:평개우미탁미정복합라고잡인용우부궁산경막외마취중적효과화대신생인적영향。방법선택2012년1월지2013년3월남경의과대학제일부속의원단태족월임신의재경막외마취하행자궁하단부궁산술적환자60례。채용수궤수자표법,장환자분위우미탁미정복합라고잡인조( RD조)、분태니복합라고잡인조( RF조)화생리염수복합라고잡인조( RN조),매조20례。경막외천자성공병배제척마후,RD조급여0.75%라고잡인15 ml복합우미탁미정1μg/kg,RF조급여0.75%라고잡인15 ml복합분태니1μg/kg,RN조급여0.75%라고잡인15 ml복합0.9%생리염수2 ml。기록마취전(T0)、경막외주약완필후10 min(T1)、30 min(T2)화술필(T3)4개시점적평균동맥압( MAP)화심솔( HR)。기록경막외조체기효시간、최고평면급체최고평면적시간,기록경막외조체지속시간화감각조체시간。기록환자적Bromage분급화Ramsay진정평분,기록술중견랍반응정도。태인면출후,추취제정맥혈진행혈기분석,병기록신생인1、5 min시적Apgar평분。결과3조환자각시점간MAP、HR화Bromage분급비교차이무통계학의의(P>0.05)。여RN조비교,RD조화RF조적기효시간、체최고조체평면시간축단[(6.3±2.4)、(8.7±2.3) min 비(10.9±2.7) min,(11.5±3.9)、(16.2±4.6) min 비(19.8±5.2) min,P<0.05],조체지속시간、감각조체시간연장[(22.5±4.6)、(18.5±3.9)min 비(13.5±3.8)min,(415±92)、(355±86)min 비(273±68)min, P<0.05],최고조체평면고,진정정도고,술중견랍반응경,RD조한전적발생솔저(5%비40%,P<0.05),RF조두훈적발생솔고(20%비0%,P<0.05)。여RF조비교,RD조적기효시간、체최고조체평면시간축단,조체지속시간、감각조체시간연장,안정합작정도고,기수발생솔저。3조제정맥혈기분석、신생인출생후1 min화5 min시적Apgar평분적비교차이균무통계학의의(균P>0.05)。결론라고잡인복합우미탁미정가축단경막외마취기효시간、연장감각조체시간、증가술중산부안정합작정도、강저술중견랍반응화억제한전적발생,이대신생인몰유불량영향。
Objective To explore the anesthetic effect and neonatal effects of dexmedetomidine combined with ropivacaine in the cesarean section under epidural anesthesia .Methods Between January 2012 and March 2013 at the First Affiliated Hospital with Nanjing Medical University , sixty parturients with a single baby at full term in vertex presentation scheduled for caesarean section under epidural anesthesia , were randomly divided into 3 groups (n=20 each) according to the random digits table:dexmedetomidine +ropivacaine ( RD ) , fentanyl +ropivacaine ( RF ) and normal saline +ropivacaine ( RN ) . After identification of the epidural space and a negative aspiration test for blood or cerebrospinal fluid , 15 ml of 0.75% ropivacaine , was administered epidurally in three the groups with addition of 1 μg/kg of dexmedetomidine in RD group , 1 μg/kg of fentanyl in RF group and 2 ml of normal saline in RN group. Recording the mean arterial pressure ( MAP) and heat rate ( HR) before anesthesia ( T0 ) , at 10 min ( T1 )and 30 min (T2) after the end of epidural administration, and at end of operation (T3).Recording the onset time, maximum sensory analgesic level , time to maximum sensory analgesic level , time to two segmental dermatomal regressions , and time to chief complaint of postoperative pain .The modified bromage degrees , sedation scores and traction reaction were also assessed .The Apgar scores at 1 and 5 min were also recorded after delivery, and the blood samples were drawn from umbilical vein for gas analysis .Results MAP, HR and the motor block ( Bromage scale ) were no statistics differences among the three groups ( P>0.05 ) . Compared with RN group , the onset time and the time to maximum sensory analgesic level were significantly earlier [(6.3 ±2.4), (8.7 ±2.3) min vs(10.9 ±2.7) min; (11.5 ±3.9), (16.2 ±4.6) min vs (19.8 ±5.2) min ,P<0.05], the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain were prolonged significantly [(22.5 ±4.6), (18.5 ±3.9) min vs(13.5 ± 3.8)min;(415 ±92), (355 ±86) min vs( 273 ±68) min,P<0.05], level of sedation and degree of traction reaction were better in RD group and in RF group , and the incidence of shivering was lower in RD group (5% vs 40%, P<0.05), the incidence of dizziness was higher in RF group (20% vs 0, P <0.05).Compared with RF group, the same results were also seen about the onset time , the time to maximum sensory analgesic level , the time to two segmental dermatomal regressions and the time to chief complaint of postoperative pain , and the level of sedation was better , the incidence of drowsiness was lower in RD group.There were no statistics differences about both the blood gas analysis of umbilical vein and the Apgar scores at 1 and 5 min after delivery.Conclusion Administration of dexmedetomidine combined with ropivacaine can provide early onset , establishment of sensory anesthesia , much better sedation levels , decrease the degree of traction reaction and the incidence of shivering , and without adverse neonatal effects .