右美托咪定在剖宫产手术中的镇静效果及对新生儿Apgar评分的影响

目的 探讨剖宫产手术麻醉中使用右美托咪定的镇静效果以及对新生儿的Apgar评分的影响。方法 选择广东省云浮市人民医院腰硬联合麻醉行剖宫产手术的孕妇240例,将其随机分为四组,每组60例,右美托咪定三组(A、B、C组);生理盐水对照组(D组)。麻醉操作前A、B、C三组分别开始以微泵持续泵入右美托咪定0.6、0.8、1μg/kg,时间设定为15 min;D组注射相同剂量的生理盐水,四组孕妇均于L3~L4间隙行腰硬联合麻醉,于注药前(T0)、注药后10 min(T1)、注药后20 min(T2)、注药后30 min(T3)对孕妇进行Ramsay镇静水平评分,于T0和T2进行焦虑视觉类比试验(AVAT)和状态焦虑问卷测试(SAI)并记录,连续监测HR、SpO2、MAP,并记录T0、T1、T2、T3时的测定值,比较各组新生儿1、5、10 min的Apgar评分。结果 A、B、C三组孕妇T2时AVAT值[(23.7±11.8)、(22.1±12.3)、(23.5±11.7)]明显低于T0[(39.8±17.1)、(42.5±18.3)、(40.7±17.7)],差异均有统计学意义(P<0.05);A、B、C三组孕妇T2时SAI值[(33.6±6.8)、(31.1±6.5)、(30.4±6.7)]明显低于T0[(41.3±7.5)、(42.2±8.1)、(42.4±7.6)],差异均有统计学意义(P<0.05);A、B、C三组T1、T2时Ramsay评分[A组:(2.6±0.2)、(2.8±0.3)分;B组:(3.4±0.5)、(3.5±0.8)分;C组:(3.5±0.8)、(4.7±0.6)分]明显高于T0[(1.5±0.5)、(1.6±0.5)、(1.5±0.5)分],差异均有统计学意义(P<0.05);与A、B、C三组T2时的HR较T0时明显下降(P<0.05);A组的MAP在T0~T2时段平稳,而T2时B、C两组的MAP较T0明显降低,D组T1和T2时的MAP、HR与T0时比较,MAP明显下降,心率明显增快,差异均有统计学意义(P<0.05),四组孕妇的新生儿出生后1、5、10 min时的Apgar评分组间比较差异无统计学意义(P>0.05)。结论 剖宫产手术麻醉中使用右美托咪定能对孕妇产生镇静效应,对新生儿Apgar评分无影响,且使用0.6μg/kg剂量的右美托咪定的孕妇镇静水平适当,血流动力学最为稳定,值得推荐使用。

Sedative effect of Dexmedetomidine in cesarean section and its effect on neonatal Apgar score

Objective To investigate the sedative effect of Dexmedetomidine in cesarean section and affect the new-born＆#39;s Apgar score. Methods 240 cases of pregnant women with caesarean section under combined spinal-epidural anesthesia in the People＆#39;s Hospital of Yunfu City were selected, they were randomly divided into four groups, with 60 cases in each group, three Dexmedetomidine groups （group A, B, C）; saline control group （group D）, before anesthesia groups A, B, C were given the 0.6, 0.8, 1 μg/kg Dexmedetomidine micropump continuous infusion respectively, time was set for 15 minutes; group D were injected with the same dose of saline, pregnant women of four groups were given the epidural anesthesia injection at L3-L4 interspace. Pregnant women were given Ramsay sedation level score before injection （T0） recorded 10 min after injection （T1）, 20 min after injection （T2） , 30 min after injection （T3）; and the anxi-ety visual analog test （AVAT）; state anxiety inventory test （SAI） were carried out and recorded at T0, T2; continuous monitoring of HR, SpO2, MAP and the value at T0, T1, T2, T3 were recorded. The newborn Apgar score at 1, 5 min and 10 min after birth of four groups were compared. Results AVAT value of group A, B, C at T2 [（23.7±11.8）, （22.1±12.3）, （23.5±11.7）] were significantly lower than T0 [（39.8±17.1）, （42.5±18.3）, （40.7±17.7）], the differences were statistically significant （P〈0.05）;SAI value of group A, B, C at T2 [（33.6±6.8）, （31.1±6.5）, （30.4±6.7）] were significantly lower than T0 [（41.3±7.5）, （42.2±8.1）, （42.4±7.6）], the differences were statistically significant （P〈0.05）;Ramsay score of group A, B, C at T1, T2 [group A： （2.6±0.2）, （2.8±0.3） points;group B： （3.4±0.5）, （3.5±0.8） points; group C： （3.5±0.8）,＆amp;nbsp;（4.7±0.6） points] were significantly higher than T0 [（1.5±0.5）, （1.6±0.5）, （1.5±0.5） points], the differences were statisti