右美托咪定在妊娠高血压综合征产妇腰硬联合麻醉剖宫产术中的疗效分析

目的观察右美托咪定在妊娠高血压综合征产妇腰硬联合麻醉剖宫产术中的疗效。 方法随机将2017年1月至2019年10月江苏大学附属昆山医院收治的128例患有妊娠高血压综合征且行腰硬联合麻醉下剖宫产术的产妇分为右美托咪定组和对照组，分别经静脉输注右美托咪定和等量0.9%氯化钠溶液。观察右美托咪定使用前（T₀），麻醉剂使用前（T₁），麻醉剂使用20 min后（T₂），胎儿娩出时（T₃）和手术结束时（T₄）的平均动脉压（MAP）、心率和脉搏血氧饱和度（SpO₂）；采用术后疼痛视觉模拟量表（VAS）评估产妇术后1、2、6、12 h的镇痛效果；观察产妇术中、术后的不良反应（血压过低、心动过缓、过度镇静、术后2 d内胃肠道反应和呼吸抑制）发生情况。采用两独立样本t检验比较不同时间点MAP、心率、SpO₂和VAS的组间差异。采用χ²检验比较不良反应发生情况的差异。 结果右美托咪定组T₁及T₄的MAP低于同时点对照组［T₁：（105.75±15.32）mmHg vs（112.30±18.53）mmHg；T₄：（97.61±8.46）mmHg vs （102.42±14.69）mmHg］，差异具有统计学意义（t=2.178，P=0.031；t=2.271，P=0.025）；右美托咪定组T₁、T₂、T₃及T₄的心率低于同时点对照组［T₁：（95.06±9.03）次/min vs （98.61±10.35）次/min；T₂：（89.45±8.40）次/min vs（93.02±8.17）次/min；T₃：（87.20±7.48）次/min vs（89.95±8.02）次/min；T₄：（88.81±8.88）次/min vs（92.19±9.62）次/min］，差异均具有统计学意义（t=2.066，P=0.041；t=2.432，P=0.016；t=2.006，P=0.047；t=2.063，P=0.041）。右美托咪定组术后1 h、2 h的VAS疼痛评分显著低于同时点对照组［术后1 h：（2.09±0.68）分vs （2.34±0.72）分；术后2 h：（2.73±0.54）分vs （2.97±0.59）分］，差异均具有统计学意义（t=2.018，P=0.046；t=2.341，P=0.021）。2组产妇在血压过低、心动过缓及过度镇静等不良反应方面比较，差异均无统计学意义（P>0.05）。 结论右美托咪定在妊娠高血压综合征产妇腰硬联合麻醉剖宫产术中可有效控制血压、心率，是安全和有效的。

Efficacy of dexmedetomidine combined with spinal-epidural anesthesia for cesarean section in parturients with pregnancy induced hypertension syndrome

ObjectiveTo observe the efficacy of dexmedetomidine combined with spinal-epidural anesthesia for cesarean section in parturients with pregnancy induced hypertension syndrome. MethodsOne hundred and twenty-eight parturients with pregnancy induced hypertension syndrome who were admitted to the Affiliated Kunshan Hospital of Jiangsu University from January 2017 to October 2019 and received cesarean section by spinal-epidural anesthesia were randomly divided into a dexmedetomidine group and a control group. The parturients in the dexmedetomidine group received intravenous administration of dexmedetomidine, while parturients in the control group received normal saline. The mean arterial pressure (MAP), heart ratio (HR), and pulse oxygen saturation (SpO₂) were recorded before the use of dexmedetomidine (T₀), before the use of anesthetics (T₁), 20 min after the use of anesthetics (T₂), at the time of fetal delivery (T₃), and at the end of surgery (T₄). The postoperative pain visual analogue scale (VAS) was used to evaluate the analgesic effect at 1, 2, 6, and 12 h after labor operation. Adverse reactions (hypotension, bradycardia, excessive sedation, gastrointestinal reaction, and respiratory inhibition within 2 d after operation) were observed. The MAP, HR, SpO₂ and VAS at different time points between the two groups were compared by t test. The adverse reactions of the two groups were compared by χ² test. ResultsThe MAPs of the dexmedetomidine group at T₁ and T₄ were significantly lower than those of the control group T₁: (105.75±15.32) mmHg vs (112.30±18.53) mmHg, t=2.178, P=0.031; T₄: (97.61±8.46) mmHg vs (102.42±14.69) mmHg, t=2.271, P=0.025]. The HRs of the dexmedetomidine group at T₁, T₂, T₃, and T₄ were significantly lower than those of the control group T₁: (95.06±9.03)/min vs (98.61±10.35)/min, t=2.066, P=0.041; T₂: (89.45±8.40)/min vs (93.02±8.17)/min, t=2.432, P=0.016; T₃: (87.20±7.48)/min vs (89.95±8.02)/min, t=2.006, P=0.047; T₄: (88.81±8.88)/min vs (92.19±9.62)/min, t=2.063, P=0.041]. The VAS scores of the dexmedetomidine group at 1 h and 2 h after operation were significantly lower than those of the control group (2.09±0.68) vs (2.34±0.72), t=2.018, P=0.046; (2.73±0.54) vs (2.97±0.59), t=2.341, P=0.021]. There was no significant difference in adverse reactions such as hypotension, bradycardia, and oversedation between the two groups (P>0.05). ConclusionDexmedetomidine combined with spinal-epidural anesthesia for cesarean section in parturients with pregnancy induced hypertension syndrome can effectively control blood pressure and heart rate, and is effective and safe.