硬膜外使用右美托咪定与罗哌卡因复合液在二次剖宫产术中的应用

　　[摘要]目的 觀察硬膜外使用右美托咪定与罗哌卡因复合液在二次剖宫产术中的应用效果。方法 随机选择2015年12月～2016年12月于江苏省妇幼保健院产科就诊、拟行二次子宫下段剖宫产术、麻醉方式为连续硬膜外麻醉的40例单胎足月产妇，采用随机数字表法分为D组（硬膜外应用0.5 μg/k g的右美托咪定2 ml与0.75%罗哌卡因15 ml的混合液）和R组（硬膜外应用0.75%的罗哌卡因15 ml与生理盐水2 ml的复合液），每组20例。记录两组麻醉前（T0），硬膜外注药完毕后10 min时（T1）、30 min时（T2）、和术毕（T3）4个时点的MAP和HR，比较两组的硬膜外阻滞起效时间、最高平面、达最高平面时间及感觉阻滞时间，观察两组的T2时点改良Bromage分级、术中Ramsay镇静评分和牵拉反应程度，记录两组的胎儿娩出前使用瑞芬太尼的例数及产妇发生呼吸抑制和寒战的例数。结扎脐带后，自脐静脉抽取血液1 ml留做血气分析，记录并比较新生儿1、5 min Apgar评分。结果 两组产妇各时点的MAP、HR水平比较，差异无统计学意义（P>0.05）。D组患者的麻醉起效时间、阻滞平面达最高时间短于R组，感觉阻滞时间长于R组，差异有统计学意义（P<0.05）。D组产妇的镇静满意度高于R组，术中牵拉反应轻于R组，使用瑞芬太尼所占比例低于R组，呼吸抑制发生率低于R组，差异有统计学意义（P<0.05）。D组新生儿出生后1 min时的Apgar评分高于R组，差异有统计学意义（P<0.05）。结论 与单独使用罗哌卡因相比，硬膜外使用右美托咪定与罗哌卡因复合液可增强二次剖宫产术硬膜外麻醉效果，同时对产妇生命体征、新生儿内环境无明显影响。
　　[关键词]右美托咪定；硬膜外麻醉；二次剖宫产术
　　[中图分类号] R719.8 [文献标识码] A [文章编号] 1674-4721（2018）2（b）-0113-04
　　Application of epidural use of compound solution of Dexmedetomidine and Ropivacaine on patients undergoing repeated cesarean section
　　WU Xia1 YU Li1 JIANG Xiu-hong1 HE Ming-feng2
　　1.Department of Anesthesiology，Women and Children Health Care Hospital of Jiangsu Province，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210036，China；2.Department of Anesthesiology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，China
　　[Abstract]Objective To observe the effect of epidural use of Dexmedetomidine and Ropivacaine on patients undergoing repeated cesarean section.Methods A total of 40 parturient，treated in Jiangsu Women and Children Health Care Hospital from December 2015 to December 2016，scheduled for repeated cesarean section under epidural anesthesia were selected randomly.According to the random number table method，the patients were divided into group D and group R，with 20 patients in each group.0.75% Ropivacaine 15 ml was administered epidurally，with addition of 0.5 μg/kg of Dexmedetomidine in group D，and 2 ml of normal saline in group R.Mean arterial pressure （MAP），heart rate （HR） before anesthesia （T0），at 10 min after administration of the specific drugs （T1），at 30 min after administration of the specific drugs （T2），and end of surgery （T3） were recorded.The onset time of epidural sensory block，maximum sensory analgesic level，the time to maximum sensory analgesic level，the time of sensory block were collected.The modified Bromage scale，Ramsay grade and grade of traction reaction at T2，cases who used remifentanil，incidence of respiration inhibition and shiver were also assessed.Blood from umbilical veins was collected for blood gas analysis.The Apgar scores were evaluated at 1 and 5 min.Results There was no significant difference in the MAP and HR at T0，T1，T2 and T3 between the two groups （P>0.05）.The onset time of epidural sensory block and the time to maximum sensory analgesic level in group D was shorter than that in group R，and the time of sensory block in group D was longer than that of group R，with significant difference （P<0.05）.The degree of sedative satisfaction in group D was higher than that in group R，the effect of traction reaction in the operation in group D was less than that of group R，and the proportion of the use of Remifentanil in group D was lower than that of group R，and the incidence of respiratory inhibition in group D was lower than that in group R，with significant difference （P<0.05）.The score of Apgar at 1 min after birth in group D was higher than that in group R，with significant difference （P<0.05）.Conclusion For patients undergoing repeated cesarean section，epidural use of Dexmedetomidine combined with Ropivacaine can enhance the anesthetic effect，without obvious adverse maternal or neonatal effects.

相关热词搜索：复合 卡因 剖宫产 硬膜外 右美托咪定