右美托咪定复合罗哌卡因腰麻-硬膜外麻醉用于剖宫产术的效果分析

目的:观察右美托咪定静脉给药应用于罗哌卡因腰麻-硬膜外麻醉下行剖宫产术的效果。方法:将择期行剖宫产手术、美国麻醉师协会(ASA)I或II级的136例产妇随机分为右美托咪定复合罗哌卡因组(Dex组)和罗哌卡因组(Rop组),每组68例。Dex组蛛网膜下腔给予0.75%罗哌卡因12 mg并静脉注射负荷剂量0.2μg/kg、维持剂量0.5μg/(kg·h)的右美托咪定至手术结束;Rop组蛛网膜下腔给予0.75%罗哌卡因12 mg并持续静脉注射与Dex组右美托咪定等量的0.9%氯化钠液至手术结束。观察两组麻醉效果、对新生儿的影响及不良反应率。结果:Dex组麻醉起效时间、达到完全运动阻滞时间、BIS分值及Ramsay改良评分均明显短于Rop组(P0.05),而Dex组最平面恢复时间则明显长于Rop组(P0.05)。Dex组和Rop组胎儿娩后1 min、5 min、10 min的新生儿Apgar评分均无统计学差异(P0.05)。Dex组产妇寒战和焦虑的发生率均明显低于Rop组,而其他不良反应差异无统计学意义。结论:右美托咪定静脉注射联合罗哌卡因腰麻-硬膜外麻醉可明显缩短麻醉起效时间、延长麻醉时间,具有更好的镇静效果。

Effects of Dexmedetomidine on Ropivacaine Combined Spinal-Epidural Anesthesia in Patients Receiving Cesarean Section

Objective：To investigate the efficacy of dexmedetomidine intravenously with ropivacaine combined spinal-epidural anesthesia in patients receiving cesarean section. Methods： A total of 136 American Society of Anesthesiologists（ASA） Ⅰ-Ⅱ parturients planned to receive cesarean section were enrolled and randomly devided into Dex group and the Rop group, with 68 cases in each group. All parturients had combined spinal-epidural anesthesia with 12 mL of 0.75 % ropivacaine. In Dex group, parturients were administered intravenously dexmedetomidine at a load dose of 0.2μg/kg and a maintenance dose of 0.5 μg/（kg·h） during the operation. While parturients in the Rop group were administered infusionously normal saline at the same dose and duration. The anesthesia efficiency, effects on neonates and the adverse effects in the two groups were observed. Results： Compared with the Rop group, the onset time of spinal anesthesia, time to achieve complete motor block. The Bispectral index （BIS） value and the Ramsay Score was statistically shorter in Dex Group（P〈0.05）. However, the recovery time was significantly longer than that in Rop group （P〈0.05）. No statistically significant differences were found in the Apgar scores at 1 min, 5 min and 10 min between Dex group and Rop group （P〈0.05）. There were no significant differences of adverse effects were found between the two groups, except that the incidences of shivering and anxiety were lower in Dex group. Conclusions： Intravenous dexmedetomidine could shorten the onset time and duration of ropivacaine combined spinal-epidural anesthesia and provide better sedation efficiency with acceptable safety.