右美托咪定联合氯普鲁卡因在剖宫产硬膜外麻醉中的应用效果
Effect of dexmedetomidine combined with chloroprocaine on epidural anesthesia for cesarean section
刘俊涛 1王岩 1丁洁羽1
作者信息
- 1. 金华市人民医院麻醉科,金华 321000
- 折叠
摘要
目的 探讨右美托咪定联合氯普鲁卡因在剖宫产硬膜外麻醉中的应用效果.方法 采取前瞻性研究,选取2020年1月至2022年12月金华市人民医院麻醉科行剖宫产硬膜外麻醉产妇133例采用病例对照,按照随机数字表法分为罗哌卡因组(66例)与氯普鲁卡因组(67例).罗哌卡因组予以右美托咪定联合罗哌卡因麻醉,氯普鲁卡因组予以右美托咪定联合氯普鲁卡因麻醉.观察两组的麻醉效果(麻醉起效时间、麻醉持续时间、达峰效应时间)、血压变化(收缩压、舒张压)、不良反应(术中寒战、恶心呕吐、尿潴留、皮肤瘙痒、下肢麻木)以及肌松满意度.结果 氯普鲁卡因组的麻醉起效时间、麻醉持续时间、达峰效应时间分别为(6.91±1.54)min、(61.54±5.31)min、(11.79±4.12)min,均短于罗哌卡因组的(9.65±1.92)min、(83.57±6.69)min、(18.32±4.81)min,差异均有统计学意义(t=9.08、21.05、8.41,均P＜0.001);两组麻醉10 min、麻醉结束时的收缩压、舒张压均升高,但氯普鲁卡因组的升高幅度较小,两组的组间、时点间、组间·时点间交互作用比较,差异均有统计学意义(F=7.36,P＜0.001;F=10.03,P＜0.001;F=9.83,P＜0.001 与 F=5.12,P=0.001;F=6.72,P＜0.001;F=8.01,P＜0.001);氯普鲁卡因组的不良反应发生率为4.48％(3/67),低于罗哌卡因组的15.15％(10/66),差异有统计学意义(x2=4.29,P＜0.05);氯普鲁卡因组的肌松满意度为94.03％(63/66),高于罗哌卡因组的81.82％(54/66),差异有统计学意义(Z=5.73,P＜0.05).结论 右美托咪定联合氯普鲁卡因在剖宫产硬膜外麻醉中的应用效果较好,可提高麻醉效果,稳定产妇血压,减少不良反应,且肌松满意度高,值得应用.
Abstract
Objective To investigate the effect of dexmedetomidine combined with chloroprocaine on epidural anesthesia for cesarean section.Methods A total of 133 women who underwent epidural anesthesia for cesarean section at the Department of Anesthesiology,Jinhua People's Hospital between January 2020 and December 2022 were included in this prospective case-control study.These women were divided into a ropivacaine group(n=66)and a chloroprocaine group(n=67)using a random number table method.The ropivacaine group received epidural anesthesia with dexmedetomidine combined with ropivacaine,while the chloroprocaine group received epidural anesthesia with dexmedetomidine combined with chloroprocaine.The anesthesia effect(anesthesia onset time,anesthesia duration,peak effect time),changes in blood pressure(systolic blood pressure,diastolic blood pressure),adverse reactions(shivering,nausea and vomiting,urinary retention,skin itching,numbness of lower limbs),and satisfaction with muscle relaxation were observed in the two groups.Results The anesthesia onset time,anesthesia duration,and peak effect time in the chloroprocaine group were(6.91±1.54)minutes,(61.54±5.31)minutes,and(11.79±4.12)minutes,respectively,which were significantly shorter than those in the ropivacaine group[(9.65±1.92)minutes,(83.57±6.69)minutes,(18.32± 4.81)minutes,t=9.08,21.05,8.41,all P＜0.001).The systolic and diastolic blood pressure increased in both groups after 10 minutes of anesthesia and at the end of the procedure;however,the increments observed in the chloroprocaine group were relatively smaller.There were significant differences in systolic and diastolic blood pressure,measured at 10 minutes of anesthesia and at the end of the procedure,between the two groups(F=7.36,P＜0.001;F=5.12,P=0.001).There were significant differences in systolic and diastolic blood pressure between different time points(F=10.03,P＜0.001;F=6.72,P＜0.001).The group-by-time interaction effect on systolic and diastolic blood pressure was also highly significant(F=9.83,P＜0.001;F=8.01,P＜0.001).The chloroprocaine group exhibited a significantly lower incidence of adverse reactions compared with the ropivacaine group[4.48％(3/67)vs.15.15％(10/66),x2=4.29,P＜0.05).Additionally,the chloroprocaine group had a significantly higher satisfaction rate with muscle relaxation compared with the ropivacaine group[94.03％(63/66)vs.81.82％(54/66),Z=5.73,P＜0.05].Conclusion The combination of dexmedetomidine and chloroprocaine offers remarkable benefits in epidural anesthesia for cesarean sections.This combined approach not only enhances epidural anesthesia but also stabilizes the blood pressure of puerperants,reduces adverse reactions,and provides exceptional muscle relaxation.It deserves consideration for clinical application.
关键词
剖宫产术/麻醉,硬膜外/血压/肌松弛/药物相关性副作用和不良反应/右美托咪定/氯普鲁卡因/罗哌卡因Key words
Cesarean section/Anesthesia,epidural/Blood pressure/Muscle relaxation/Drug-related side effects and adverse reactions/Dexmedetomidine/Chloroprocaine/Ropivacaine引用本文复制引用
出版年
2024
NETL
NSTL
万方数据