[目的]探讨剖宫产行腰硬联合麻醉(CSEA)加用右美托咪定(Dex)的镇痛效果及对产妇术后睡眠质量和抑郁发生风险的影响.[方法]70例剖宫产产妇,随机分为观察组和对照组,每组35例.对照组采取CSEA,观察组在此基础上加用Dex,比较两组镇静评分量表(Ramsay)评分、视觉模拟疼痛量表(VAS)评分,手术前后睡眠质量、抑郁评分,血流动力学及不良反应发生情况和新生儿Apgar评分.[结果]两组产妇麻醉后Ramsay评分高于麻醉即刻,术后24 h VAS评分高于术后1 h(P＜0.05),且观察组麻醉后Ramsay评分高于对照组,术后24 h VAS评分低于对照组(P＜0.05);两组产妇术后阿森斯失眠量表(AIS)评分高于术前,术后抑郁自评量表(SDS)评分低于术前(P＜0.05),且观察组术后AIS评分、SDS评分低于对照组(P＜0.05);观察组新生儿呼吸、心率、皮肤颜色评分显著高于对照组(P＜0.05),两组肌张力、喉反射评分比较,差异无统计学意义(P＞0.05);两组产妇术后血氧饱和度(SpO2)水平比较,差异无统计学意义(P＞0.05),心率(HR)、平均动脉压(MAP)水平显著低于术前(P＜0.05),观察组术后HR、MAP水平高于对照组(P＜0.05);观察组不良反应总发生率显著低于对照组(P＜0.05).[结论]剖宫产术行CSEA加用Dex镇痛、镇静效果显著,可有效减轻产妇疼痛症状,改善其睡眠质量以及抑郁情绪,值得临床推广应用.
Effect of Dexmedetomidine Combined with Spinal-Epidural Anesthesia on Analgesia,Postopera-tive Sleep and Incidence of Depression in Parturients with Cesarean Section
[Objective]This study aims to explore the analgesic effects of Dexmedetomidine(Dex)com-bined with Spinal-Epidural Anesthesia(CSEA)on analgesia,postoperative sleep quality and risk of depression during cesarean delivery.[Methods]Seventy parturients undergoing cesarean section were randomly divided in-to the observation group and the control group,with 35 subjects in each group.The control group received CSEA,and the observation group received Dex in addition to CSEA.The sedation score(Ramsay),visual ana-log scale(VAS)for pain,preoperative and postoperative sleep quality,depression scores,hemodynamics,ad-verse reactions,and neonatal Apgar scores were compared between the groups.[Results]Post-anesthesia Ram-say scores in both groups were higher immediately after anesthesia;And the 24-hour postoperative VAS scores were higher than those at 1-hour post-surgery(P＜0.05).The observation group showed higher post-anes-thesia Ramsay scores and lower 24-hour postoperative VAS scores compared to the control group(P＜0.05).Postoperative Athens Insomnia Scale(AIS)scores in both groups were higher than those preoperative scores,and postoperative Self-Rating Depression Scale(SDS)scores were lower than those preoperative scores in both groups(P＜0.05),with the observation group showing lower postoperative AIS and SDS scores than the control group(P＜0.05).The observation group's neonatal respiratory,heart rate,and skin color scores were significantly higher than those in the control group(P＜0.05),while there were no significant differences in muscle tone and laryngeal reflex scores between the groups(P＞0.05).There was no significant difference in postoperative oxygen saturation(SpO2)levels between the groups(P＞0.05),however,the heart rate(HR)and mean arterial pressure(MAP)were significantly lower postoperatively than preoperatively(P＜0.05),with higher postoperative HR and MAP levels in the observation group(P＜0.05).The overall incidence of adverse reactions was significantly lower in the observation group(P＜0.05).[Conclusion]The use of Dex combined with CSEA for cesarean delivery significantly enhances analgesia and sedation with effectively reduc-ing pain,improving sleep quality,and alleviating depressive symptoms,It is worthy of clinical application.
万方数据
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