目的 分析不同剂量右美托咪定(Dex)复合腰硬联合麻醉对产科手术中麻醉效果、血压及视觉模拟评分法(VAS)评分的影响。方法 200例产妇作为观察对象，根据Dex剂量不同分为对照组(C组)、低剂量组(D1组)、中剂量组(D2组)、中-高剂量组(D3组)和高剂量组(D4组)，每组40例。对比五组不同时段Ramsay评分、视觉模拟评分法(VAS)评分、血压水平、不良反应发生率、新生儿1 min及5 min Apgar评分。结果 入室麻醉后平卧位即刻(T0)，五组产妇Ramsay、VAS评分对比差异无统计学意义(P>0。05);胎儿娩出时(T1)，D2组、D3组及D4组产妇Ramsay评分分别为(4。92±0。11)、(4。95±0。13)、(4。88±0。11)分，明显高于C组的(2。84±0。24)分与D1组的(3。12±0。14)分，VAS评分分别为(2。06±0。22)、(2。03±0。19)、(2。02±0。19)分，明显低于C组的(4。13±0。24)分与D1组的(3。13±0。27)分，且D1组产妇Ramsay评分明显高于C组，VAS评分明显低于C组(P<0。05);术后12 h(T2)，D2组、D3组及D4组产妇VAS评分分别为(2。46±0。37)、(2。49±0。36)、(2。42±0。34)分，明显低于C组的(5。13±0。24)分与D1组的(4。05±0。71)分，且D1组产妇VAS评分明显低于C组(P<0。05);D2组、D3组及D4组产妇T1时的Ramsay、VAS评分及T2时的VAS评分对比差异无统计学意义(P>0。05)。五组新生儿1 min及5 min Apgar评分对比差异无统计学意义(P>0。05)。T0时，五组产妇收缩压及舒张压水平对比差异无统计学意义(P>0。05);T1、T2时，D2组、D3组及D4组产妇收缩压及舒张压水平明显低于C组与D1组，且D1组产妇收缩压及舒张压水平明显低于C组(P<0。05);D2组、D3组及D4组产妇T1、T2时的收缩压及舒张压水平对比差异无统计学意义(P>0。05)。D2组产妇不良反应发生率2。5％(1/40)低于C组的15。0％(6/40)、D1组的15。0％(6/40)、D3组的15。0％(6/40)、D4组的17。5％(7/40)(P<0。05)。结论 0。5μg/kg Dex有助于稳定血压水平，提高麻醉效果，减轻术中疼痛，降低麻醉后不良反应发生率，且不会对新生儿出生造成不利影响，可作为最佳调控剂量。
Effects of different doses of dexmedetomidine combined with combined spinal-epidural anesthesia on anesthetic effect and blood pressure during obstetric surgery and VAS score
Objective To analyze the effects of different doses of dexmedetomidine (Dex) combined with combined spinal-epidural anesthesia on anesthetic effect and blood pressure during obstetric surgery and visual analogue scale (VAS) score.Methods 200 parturients as observation subjects were divided into control group (Group C),low-dose group (Group D1),medium-dose group (Group D2),medium-high-dose group (Group D3) and high-dose group (Group D4) according to the different doses of Dex,with 40 cases in each group.Ramsay score,visual analog scale (VAS) score and blood pressure level at different time points,incidence of adverse reactions,and neonatal 1 min and 5 min Apgar scores were compared among the five groups.Results There was no statistically significant difference in Ramsay and VAS scores among the five groups of parturients immediately after anesthesia in the supine position (T0) (P>0.05).At the time of delivery (T1),the maternal Ramsay scores were (4.92±0.11),(4.95±0.13) and (4.88±0.11) points in Group D2,Group D3 and Group D4,which were significantly higher than (2.84±0.24) points in Group C and (3.12±0.14) points Group D1;VAS scores were (2.06±0.22),(2.03±0.19) and (2.02±0.19) points in Group D2,Group D3 and Group D4,which were significantly lower than (4.13±0.24) points in Group C and (3.13±0.27) points in Group D1;Ramsay score in Group D1 was significantly higher than that in Group C,and VAS score was significantly lower than that in Group C (P<0.05).At 12 h postoperatively (T2),the maternal VAS scores were (2.46±0.37),(2.49±0.36) and (2.42±0.34) points in Group D2,Group D3 and Group D4,which were significantly lower than (5.13±0.24) points in Group C and (4.05±0.71) points in Group D1;the maternal VAS score in Group D1 was significantly lower than that in Group C (P<0.05).There was no statistically significant difference in the comparison of maternal Ramsay and VAS scores at T1 and VAS scores at T2 among Group D2,Group D3 and Group D4 (P>0.05).There was no statistically significant difference in the comparison of neonatal 1-min and 5-min Apgar scores among the five groups (P>0.05).At T0,there was no statistically significant difference in the comparison of levels of maternal systolic and diastolic blood pressure among the five groups (P>0.05).At T1 and T2,the levels of systolic and diastolic blood pressure in Group D2,Group D3 and Group D4 were significantly lower than those in Group C and Group D1;and the levels of systolic and diastolic blood pressure in Group D1 were significantly lower than those in Group C (P<0.05).At T1 and T2,there was no statistically significant difference in the levels of systolic and diastolic blood pressure among Group D2,Group D3 and Group D4 (P>0.05).The incidence rate of maternal adverse reactions was 2.5％ (1/40) in Group D2,which was lower than 15.0％ (6/40) in Group C,15.0％ (6/40) in Group D1,15.0％ (6/40) in Group D3,and 17.5％ (7/40) in Group D4 (P<0.05).Conclusion 0.5 μg/kg Dex can help to stabilize blood pressure,improve anesthesia effect,reduce intraoperative pain,reduce the incidence of adverse reactions after anesthesia,and will not adversely affect the birth of newborns,so it can be used as the optimal regulating dose.
Different dosesDexmedetomidineCombined spinal-epidural anesthesiaObstetric surgeryAnesthetic effectBlood pressureVisual analogue scale score
万方数据
维普
