中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
33期
40-43
,共4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%剖宫产术%血流动力学%新生儿
右美託咪啶%痳醉%剖宮產術%血流動力學%新生兒
우미탁미정%마취%부궁산술%혈류동역학%신생인
Dexmedetomidine%Anesthesia%Cesarean section%Haemodynamics%Newborn
目的 探讨全身麻醉剖宫产术中应用右美托咪啶对患者血流动力学和新生儿的影响.方法 选择单胎足月妊娠拟在全身麻醉下行子宫下段剖宫产术的患者38例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级.按随机数字表法分为右美托咪啶组和0.9％氯化钠组,每组19例.右美托咪啶组麻醉诱导前10 min持续输注负荷量右美托咪啶0.6tμg/kg,继以0.4μg/(kg·h)持续输注,手术关腹时停药;0.9％氯化钠组泵入等体积的0.9％氯化钠.记录两组输注前(T0)、输注10 min时(T1)、气管插管时(T2)、胎儿娩出时(T3)、胎儿娩出后15 min时(T4)、手术结束时(T5)、拔管时(T6)和拔管后15 min时(T7)的收缩压(SBP)、舒张压(DBP)和心率.胎儿娩出后,抽取脐静脉、脐动脉血进行血气分析,并记录新生儿出生后1,5 min时的Apgar评分.结果 两组患者T0时SBP、DBP和心率比较差异无统计学意义(P＞0.05).与T0比较,右美托咪啶组SBP、DBP和心率在T2明显升高[(136±12)mmHg(1 mmHg=0.133 kPa)比(124±9) mmHg,(83±10)mmHg比(72±6)mmHg,(93±11)次/min比(81±8)次/min],差异有统计学意义(P＜0.05);0.9％氯化钠组SBP、DBP和心率在T2-6均明显升高[(151±14),(137±11),(132±10),(132±9),(142±13)mmHg比(125±9)mmHg; (94±13),(85±9),(80±8),(80±9),(86±11) mmHg比(74±7)mmHg;(122±15),(105±12),(90±9),(89±10),(97±11)次/min比(81±9)次/min],差异有统计学意义(P＜0.05).与0.9％氯化钠组相同时间比较,右美托咪啶组SBP、DBP和心率在T2-6均明显降低,差异有统计学意义(P＜0.05).两组脐静脉、脐动脉血血气分析和新生儿出生后1,5 min Apgar评分比较差异均无统计学意义(P＞0.05).结论 全身麻醉剖宫产术中应用右美托咪啶有利于维持母体血流动力学的稳定而对新生儿没有不良影响.
目的 探討全身痳醉剖宮產術中應用右美託咪啶對患者血流動力學和新生兒的影響.方法 選擇單胎足月妊娠擬在全身痳醉下行子宮下段剖宮產術的患者38例,美國痳醉醫師協會(ASA)分級Ⅰ或Ⅱ級.按隨機數字錶法分為右美託咪啶組和0.9％氯化鈉組,每組19例.右美託咪啶組痳醉誘導前10 min持續輸註負荷量右美託咪啶0.6tμg/kg,繼以0.4μg/(kg·h)持續輸註,手術關腹時停藥;0.9％氯化鈉組泵入等體積的0.9％氯化鈉.記錄兩組輸註前(T0)、輸註10 min時(T1)、氣管插管時(T2)、胎兒娩齣時(T3)、胎兒娩齣後15 min時(T4)、手術結束時(T5)、拔管時(T6)和拔管後15 min時(T7)的收縮壓(SBP)、舒張壓(DBP)和心率.胎兒娩齣後,抽取臍靜脈、臍動脈血進行血氣分析,併記錄新生兒齣生後1,5 min時的Apgar評分.結果 兩組患者T0時SBP、DBP和心率比較差異無統計學意義(P＞0.05).與T0比較,右美託咪啶組SBP、DBP和心率在T2明顯升高[(136±12)mmHg(1 mmHg=0.133 kPa)比(124±9) mmHg,(83±10)mmHg比(72±6)mmHg,(93±11)次/min比(81±8)次/min],差異有統計學意義(P＜0.05);0.9％氯化鈉組SBP、DBP和心率在T2-6均明顯升高[(151±14),(137±11),(132±10),(132±9),(142±13)mmHg比(125±9)mmHg; (94±13),(85±9),(80±8),(80±9),(86±11) mmHg比(74±7)mmHg;(122±15),(105±12),(90±9),(89±10),(97±11)次/min比(81±9)次/min],差異有統計學意義(P＜0.05).與0.9％氯化鈉組相同時間比較,右美託咪啶組SBP、DBP和心率在T2-6均明顯降低,差異有統計學意義(P＜0.05).兩組臍靜脈、臍動脈血血氣分析和新生兒齣生後1,5 min Apgar評分比較差異均無統計學意義(P＞0.05).結論 全身痳醉剖宮產術中應用右美託咪啶有利于維持母體血流動力學的穩定而對新生兒沒有不良影響.
목적 탐토전신마취부궁산술중응용우미탁미정대환자혈류동역학화신생인적영향.방법 선택단태족월임신의재전신마취하행자궁하단부궁산술적환자38례,미국마취의사협회(ASA)분급Ⅰ혹Ⅱ급.안수궤수자표법분위우미탁미정조화0.9％록화납조,매조19례.우미탁미정조마취유도전10 min지속수주부하량우미탁미정0.6tμg/kg,계이0.4μg/(kg·h)지속수주,수술관복시정약;0.9％록화납조빙입등체적적0.9％록화납.기록량조수주전(T0)、수주10 min시(T1)、기관삽관시(T2)、태인면출시(T3)、태인면출후15 min시(T4)、수술결속시(T5)、발관시(T6)화발관후15 min시(T7)적수축압(SBP)、서장압(DBP)화심솔.태인면출후,추취제정맥、제동맥혈진행혈기분석,병기록신생인출생후1,5 min시적Apgar평분.결과 량조환자T0시SBP、DBP화심솔비교차이무통계학의의(P＞0.05).여T0비교,우미탁미정조SBP、DBP화심솔재T2명현승고[(136±12)mmHg(1 mmHg=0.133 kPa)비(124±9) mmHg,(83±10)mmHg비(72±6)mmHg,(93±11)차/min비(81±8)차/min],차이유통계학의의(P＜0.05);0.9％록화납조SBP、DBP화심솔재T2-6균명현승고[(151±14),(137±11),(132±10),(132±9),(142±13)mmHg비(125±9)mmHg; (94±13),(85±9),(80±8),(80±9),(86±11) mmHg비(74±7)mmHg;(122±15),(105±12),(90±9),(89±10),(97±11)차/min비(81±9)차/min],차이유통계학의의(P＜0.05).여0.9％록화납조상동시간비교,우미탁미정조SBP、DBP화심솔재T2-6균명현강저,차이유통계학의의(P＜0.05).량조제정맥、제동맥혈혈기분석화신생인출생후1,5 min Apgar평분비교차이균무통계학의의(P＞0.05).결론 전신마취부궁산술중응용우미탁미정유리우유지모체혈류동역학적은정이대신생인몰유불량영향.
Objective To explore the neonatal effects and efficacy of dexmedetomidine on haemodynamics during cesarean section under general anesthesia.Methods Thirty-eight ASA Ⅰ or Ⅱ parturients with a single baby at full term in vertex presentation,scheduled for cesarean section under general anesthesia,were randomly divided into 2 groups (each group of 19 patients) by random digits table method:dexmedetomidine group and normal saline group.The patients in dexmedetomidine group received an intravenous infusion loading dose of 0.6 μ g/kg of dexmedetomidine,starting 10 min before induction of anesthesia,following with an intravenous infusion 0.4 μ g/ (kg ·h) of dexmedetomidine until peritoneal closure.The patients in normal saline group received an intravenous infusion of isovolumic of normal saline.Recording the systolic blood pressure (SBP),diastolic blood pressure (DBP) and heart rate (HR) before infusion (T0) and 10 min after the start of infusion (T1),at tracheal intubation (T2),at delivery of the baby (T3),15 min after delivery (T4),at end of operation (T5),at extubation (T6) and 15 min after extubation (T7).The blood of umbilical vein and umbilical artery was drawn for gas analysis,and the Apgar scores at 1 and 5 min were also recorded after delivery.Results The level of SBP,DBP and HR at T0 had no significant difference between two groups (P ＞ 0.05).In dexmedetomidine group,the level of SBP,DBP and HR were significantly higher at T2 than those at T0 [(136 ± 12) mmHg (1 mmHg =0.133 kPa) vs.(124 ± 9) mmHg,(83 ± 10) mmHg vs.(72 ± 6) mmHg,(93 ± 11) times/min vs.(81 ± 8) times/min] (P ＜ 0.05).In normal saline group,the level of SBP,DBP and HR at T2-6 [(151 ± 14),(137 ± 11),(132 ± 10),(132 ±9),(142± 13)mmHgvs.(125 ±9)mmHg;(94±13),(85±9),(80±8),(80±9),(86±11)mmHgvs.(74 ±7) mmHg; (122 ±15),(105 ±12),(90 ±9),(89 ± 10),(97 ±11) times/min vs.(81 ±9) times/min] were significantly lower (P ＜ 0.05).Compared with normal saline group,the level of SBP,DBP and HR were lower in dexmedetomidine group at T2-6(P ＜ 0.05).There were no significant difference not only about the blood gas analysis of umbilical vein and umbilical artery,but also about the Apgar scores at 1 and 5 min after delivery (P ＞ 0.05).Conclusion Administration of dexmedetomidine is effective in maintaining the maternal haemodynamic during the cesarean section under general anesthesia without adverse neonatal effects.
