剖宮產術中應用右美托咪定對椎管內麻醉期間 寒顫、牽拉反應的預防效果探討

趙艷東 王青華

[摘要] 目的 探討剖宮產術中應用右美托咪定對椎管內麻醉期間寒顫、牽拉反應的預防效果。 方法 入選2018年1～10月的剖宮產患者80例，隨機分成對照組與觀察組，各40例，兩組患者在分娩中以剖宮產的方式分娩，并在胎兒剖出之后，對照組給予生理鹽水進行靜脈滴注，觀察組應用右美托咪定靜脈滴注，經過不同的干預治療后比較兩組對椎管內麻醉期間寒顫、牽拉反應的預防效果。 結果 觀察組的寒顫發生率為12.50%，明顯低于對照組的25.00%，差異有統計學意義（P<0.05）。在牽拉反應的預防中，觀察組的預防優良率為90.00%，明顯高于對照組的77.50%，差異有統計學意義（P<0.05）。觀察組與對照組的不良反應發生率分別為7.50%與10.00%，差異無統計學意義（P>0.05）。 結論 剖宮產術中應用右美托咪定可以對椎管內麻醉期間寒顫、牽拉反應起到良好的預防效果，值得在臨床中廣泛應用。

[關鍵詞] 剖宮產;右美托咪定;椎管內麻醉;寒顫;牽拉反應

[中圖分類號] R971? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2019）33-0116-03

[Abstract] Objective To investigate the preventive effect of dexmedetomidine on chills and traction response during spinal anesthesia in cesarean section. Methods Eighty patients who received cesarean section from January to October 2018 were enrolled and randomLy divided into the control group and the observation group， each had 40 cases. Cesarean section was selected as the delivery method in both groups. After the fetuses were born， the control group was given intravenous infusion of saline and the observation group was given intravenous infusion of dexmedetomidine. After different intervention treatment， the preventive effects on chills and traction response during spinal anesthesia were compared between the two groups. Results The incidence of chills in the observation group was 12.50%， which was significantly lower than the 25.00% in the control group， with statistically significant difference（P<0.05）. In the prevention of traction response， the excellent and good rate of prevention in the observation group was 90.00%， which was significantly higher than the 77.50% of the control group， with statistically significant difference（P<0.05）. The incidences of adverse reactions in the observation group and the control group were 7.50% and 10.00%， respectively， with no statistically significant difference（P>0.05）. Conclusion The use of dexmedetomidine in cesarean section shows a good preventive effect on chills and traction response during spinal anesthesia， which is worthy of wide clinical application.

[Key words] Cesarean section; Dexmedetomidine; Spinal anesthesia; Chills; Traction response

分娩是胎兒自母體離開而獨立的過程，是終止妊娠的生理過程，分娩時產婦可以通過產道自然分娩出胎兒，也可經腹部切開子宮將胎兒分娩出，即在臨床中分娩方式包括自然分娩和剖宮產分娩，雖然自然分娩為有利于胎兒和母體的分娩方式，但是在臨床中剖宮產同時占有較高的比例[1]。特別是隨著營養水平的提高，胎兒過大的比例在不斷增加，進而剖宮產在臨床中的應用率不斷增加，剖宮產手術前麻醉一般采取腰椎管內的麻醉，麻醉后患者出現寒顫;牽拉反應等并發癥的情況較多，患者會出現寒顫，肌肉緊張，牽拉疼痛等，容易增加機體的耗氧量，影響自身的代謝反應，在手術中出現寒顫直接影響產婦和胎兒的健康，同時寒顫和牽拉反應的發生對術后的身體恢復造成一定的不良影響，給患者的心理帶來負面的影響，容易增加產后抑郁的發生比例[2-3]。因此，有效的預防剖宮產患者椎管內麻醉期間寒顫、牽拉反應很有必要。本研究在剖宮產術中應用右美托咪定對椎管內麻醉期間寒顫、牽拉反應進行預防的效果比較突出，現報道如下。