右美托咪定聯合地佐辛對腰麻剖宮產術中牽拉反應的影響

顏廷鳳

【摘要】 目的：觀察右美托咪定聯合地佐辛在對腰麻剖宮產術中牽拉反應的影響。方法：選擇2016年1-8月在本院行腰麻剖宮產的產婦80例，采用隨機數字法分為右美托咪定+芬太尼組（對照組）和右美托咪定+地佐辛組（觀察組），每組各40例。斷臍后，兩組產婦10 min內均靜脈泵入右美托咪定0.6 μg/kg，對照組產婦靜脈注射芬太尼0.05 mg，觀察組產婦靜脈注射地佐辛5 mg。比較兩組產婦給藥前、給藥后10 min、探查時和術畢的SBP、DBP、HR、Ramsay評分以及牽拉反應情況。結果：兩組產婦腰麻后，血壓和心率較入室時均有下降（P<0.05）；對照組在探查時的血壓和心率與入室時比較，差異無統計學意義（P>0.05）；觀察組在探查時的SBP和DBP低于對照組（P<0.05）。兩組產婦在探查時的Ramsay評分較入室時均下降（P<0.01），觀察組探查時Ramsay評分高于對照組（P<0.01）。與對照組比較，觀察組術中牽拉反應較輕（P<0.01）。結論：地佐辛用于剖宮產術中抑制牽拉反應效果優于芬太尼。

【關鍵詞】 右美托咪定； 地佐辛； 芬太尼； 剖宮產； 牽拉反應

【Abstract】 Objective：To evaluate the effect of dexmedetomidine Combined with dezocine on traction reactions of spinal anesthesia in cesarean section.Method：80 cases of cesarean section undergoing lumbar anesthesia in our hospital from January to August 2016 were selected，according to the random number table method，they were randomly divided into Dexmedetomidine + Fentanyl group（control group） and Dexmedetomidine + Dezocine group（observation group），40 cases in each group.After cutting the umbilical cord，two groups were intravenous infusion of dexmedetomidine given 0.6 μg/kg within 10 min，control group was intravenous Fentanyl 0.05 mg，observation group received intravenous injection of Dezocine 5 mg.SBP，DBP，HR，Ramsay score and traction reactions were compared before the drug administration，10 min，abdominal exploration and the end of surgery.Result：Two groups had lower blood pressure and heart rate when they were pregnant（P<0.05），the blood pressure and heart rate of the control group were compared in the probe，the difference was not statistically significant（P>0.05）；the SBP and DBP in observation group was less than that in control group when abdominal exploration（P<0.05）.The ramsay score in two groups were decreased at the time of abdominal exploration compared with burglary（P<0.01），at the time of abdominal exploration，the ramsay score in observation group was higher than that in control group（P<0.01）.Compared with control group，the degree of intraoperative traction reactions in observation group was lessened（P<0.01）.Conclusion：Dezocine was better than Fentanyl on the traction reaction inhibition of cesarean section.

【Key words】 Dexmedetomidine； Dezocine； Fentanyl； Cesarean section； Traction reactions

First-authors address：Chuzhou TCM Hospital of Huaian City，Huaian 223200，China

doi：10.3969/j.issn.1674-4985.2017.25.016

腰麻是剖宮產手術常用的麻醉方法之一，但難以控制術中牽拉反應引起的疼痛、惡心嘔吐、上腹部不適等[1]。單純地提高腰麻平面并不能完全控制術中牽拉腹膜、子宮及韌帶引起的腹部疼痛不適，反而會增加腰麻并發癥的發生率[2-3]。右美托咪定作為一種新型的α2-腎上腺素能受體激動劑，將其應用老年全麻手術中有抗焦慮、鎮靜、鎮痛和神經保護的作用[4]。地佐辛是目前臨床上常用的鎮痛藥物，新近的研究報道認為，地佐辛通過激動脊髓μ受體和抑制去甲腎上腺素重攝取，產生確切的鎮痛作用[5]。本研究采用右美托咪定聯合地佐辛用于剖宮產手術，對術中牽拉引起的不適有較好的效果，現報道如下。endprint

1 資料與方法

1.1 一般資料 選擇2016年1-8月在本院行腰麻剖宮產的產婦80例，年齡20～32歲，體質量指數27.1～34.4 kg/m2，ASA Ⅰ～Ⅱ級。采用隨機數字表法分為右美托咪定+芬太尼組（對照組）和右美托咪定+地佐辛組（觀察組），每組各40例?！?br>