Clinical Effect of Dexmedetomidine on Shivering Reaction in Cesarean Section Patients during Combined Spinal-epidural Anesthesia
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摘要:
目的 探讨盐酸右美托咪定对剖宫产产妇腰硬联合麻醉期间寒战反应的防治效果。 方法 选择昆明医科大学附属延安医院2019年9月至12月在腰硬联合麻醉下行择期剖宫产手术的产妇60例，ASAⅠ～Ⅱ级，随机分为实验组（D组）和对照组（C组）。于胎儿娩出断脐后，D组产妇即刻泵注盐酸右美托咪定0.5 μg/kg；C组产妇泵注生理盐水0.5 μg/kg，均在10 min内泵完。观察记录产妇麻醉前（T0）、麻醉后5 min（T1）、胎儿娩出时（T2）、胎儿娩出后10 min（T3）、手术结束时（T4）的血压（BP）、心率（HR）、血氧饱和度（SpO2）、呼吸频率（RR）、镇静效果（按Ramsay镇静评分），密切观察寒战（寒战分级按Wrench分级）、恶心呕吐、呼吸抑制等不良反应。 结果 两组产妇血压、心率、呼吸频率相应时点组间比较，差异无统计学意义（P > 0.05）。D组产妇T3、T4时的Ramsay镇静评分明显高于T0（P < 0.05），D组产妇T3、T4时的Ramsay镇静评分显著高于C组产妇（P < 0.05），且未发现呼吸抑制。D组产妇寒战发生率明显低于C组（P < 0.05）。 结论 剖宫产产妇腰硬联合麻醉期间应用盐酸右美托咪定可有效防治寒战反应，且无呼吸抑制作用，可安全有效地应用于临床。 Abstract:Objective To study the preventive and therapeutic effect of dexmedetomidine hydrochloride on shivering reaction of caesarean section patients during combined spinal-epidural anesthesia. Methods Sixty patients undergoing caesarean section under combined spinal-epidural anesthesia in Yan'an Hospital affiliated to Kunming Medical University from September to December in 2019 were randomly divided into experimental group and control group.0.5 μg/kg. Dexmedetomidine hydrochloride was pumped within 10 minutes immediately after the umbilical cord was cut off in the experimental group. The control group was given the same dose of saline. The ECG, BP, HR, SpO2, RR, sedation（according to Ramsay sedation score）, shivering reaction（according to Wrench grade）and nausea and vomiting were observed continuously before anesthesia（T0）, 5 minutes after anesthesia（T1）, at the time of fetal delivery（T2）, 10 minutes after fetal delivery（T3）, at the end of operation（T4）. Results The level of shivering reaction in the experimental group was lower than that in the control group（P < 0.05）. There was no significant difference in BP, HR, SpO2 between the two groups at corresponding time points（P > 0.05）. Ramsay sedation score at T3 and T4 was significantly higher than that at T0 in the experimental group（P < 0.05）, and significantly higher than that in the control group（P < 0.05）. Conclusion The application of dexmedetomidine during combined spinal-epidural anesthesia in cesarean section can effectively prevent and treat shivering reaction. -
表 1 两组产妇一般资料的比较（
$\bar x \pm s$ ）Table 1. The General information of puerpera（
$\bar x \pm s$ ）组别 n 年龄（岁） 体重（kg） 手术时间（min） C组 30 31.2 ± 4.1 73.5 ± 7.8 43.0 ± 4.3 D组 30 30.8 ± 4.3 72.7 ± 7.6 44.2 ± 4.7 t 1.89 2.12 2.04 P 0.205 0.158 0.135 
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表 2 两组产妇循环指标和Ramsay镇静评分比较（
$\bar x \pm s$ ）Table 2. Comparison of circulation index and Ramsay sedation score in parturient during operation（
$\bar x \pm s$ ）指标 组别 T0 T1 T2 T3 T4 SBP（mmHg） C组 121.4 ± 10.8 116.2 ± 8.2 108.3 ± 7.8 116.1 ± 8.2 118.3 ± 7.3 D组 121.3 ± 9.4 115.8 ± 9.0 107.2 ± 8.5 115.6 ± 8.0 117.4 ± 7.8 DBP（mmHg） C组 80.2 ± 7.1 74.4 ± 6.2 73.5 ± 6.5 75.3 ± 5.8 77.5 ± 5.6 D组 80.5 ± 7.5 76.3 ± 7.2 72.8 ± 6.0 75.9 ± 6.1 76.2 ± 6.8 HR（bpm） C组 87.1 ± 8.8 82.9 ± 7.5 83.3 ± 7.7 83.2 ± 7.5 84.6 ± 7.9 D组 86.7 ± 8.6 83.1 ± 8.2 84.5 ± 8.0 82.1 ± 7.8 84.9 ± 7.0 RR（次/min） C组 19 ± 1 17 ± 1 17 ± 1 16 ± 1 17 ± 1 D组 19 ± 1 18 ± 1 16 ± 1 15 ± 1 16 ± 1 Ramsay评分 C组 1.93 ± 0.17 1.87 ± 0.15 1.83 ± 0.18 1.86 ± 0.13 1.90 ± 0.11 D组 1.92 ± 0.11 1.97 ± 0.13 1.80 ± 0.11 3.50 ± 0.27*# 3.48 ± 0.38*# 与T0比较，*P < 0.05；与C组比较，#P < 0.05。
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表 3 两组产妇手术期间寒战发生情况比较[n （%）]
Table 3. Comparison of shivering reaction in parturients[n （%）]
组别 n 0级 1级 2级 3级 4级 C 30 16（53.33） 5（16.67） 4（13.33） 3（10.00） 2（6.67） D 30 26（86.67） 3（10.00）* 1（3.33）* 0* 0* F 1.83 2.09 2.36 P 0.215 0.021 0.017 与C组比较，*P < 0.05。
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表 4 两组产妇不良反应情况比较[n （%）]
Table 4. Comparison of adverse reactions in parturients during operation[n （%）]
组别 n 恶心/呕吐 低血压 牵拉反应 C 30 3（10） 2（7） 16（53） D 30 1（3） 4（13） 3（10）* F 1.74 1.94 2.24 P 0.262 0.221 0.012 与C组比较，*P < 0.05。
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