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目的探讨子痫前期剖宫产产妇鞘内注射右美托咪定的麻醉有效性及对新生儿的影响。方法选取诊断为子痫前期拟行剖宫产的产妇100例,随机分为对照组和观察组两组,每组50例,两组给予0.5%等比重布比卡因10 mg为基础麻醉药物,观察组同时鞘内注射右美托咪定,观察麻醉后感觉和运动阻滞起效时间、持续时间,麻醉镇静效果(Richmond评分),麻醉期低血压、呼吸抑制和麻醉苏醒期寒战、恶心及呕吐等不良反应发生情况,新生儿出生1和5 min时Apgar评分,出生1和24 h时新生儿神经行为评分(NBNA)。结果观察组感觉和运动阻滞时间均明显短于对照组,感觉和运动持续时间均长于对照组,差异均有统计学意义(均P<0.05);在切皮、取出胎儿、手术结束时观察组Richmond评分低于对照组,差异均有统计学意义(均P<0.05);两组麻醉期低血压发生率比较,差异无统计学意义(P>0.05),两组均未出现呼吸抑制现象,麻醉苏醒期观察组寒战发生率4.00%低于对照组的16.00%,差异有统计学意义(P<0.05),恶心、呕吐发生率比较,差异均无统计学意义(均P>0.05);两组新生儿1和5 min时Apgar评分、1和24 h时NBNA评分比较,差异均无统计学意义(均P>0.05)。结论子痫前期剖宫产产妇以0.5%布比卡因为基础复合右美托咪定鞘内注射,可明显提高麻醉效果、降低麻醉苏醒寒战发生,对新生儿未见明显不良影响。
Objective To investigate the anesthetic effectiveness of intrathecal dexmedetomidine in preeclampsia and its effects on newborns. Methods 100 cases of maternal women scheduled for preeclampsia who were scheduled for cesarean section were randomly divided into control group and observation group with 50 cases in each group. The two groups were given 10% bupivacaine 0.5 mg as basic anesthetic , While the observation group received intrathecal dexmedetomidine. The onset and duration of anesthesia onset and duration of anesthesia, duration of anesthesia sedation (Richmond score), anesthesia hypotension, respiratory depression and anesthesia recovery chills, nausea And vomiting and other adverse reactions, Apgar score at 1 and 5 min after birth, neonatal neurobehavioral score (NBNA) at 1 and 24 h after birth. Results The sensory and motor block time in the observation group was significantly shorter than that in the control group, and the sensory and motor durations were longer than those in the control group (all P <0.05). At the time of skin incision and fetus removal, Group Richmond score lower than the control group, the difference was statistically significant (P <0.05); no significant difference in the incidence of hypotension during anesthesia between the two groups (P> 0.05), no respiratory depression in both groups (4.00%) in the anesthesia recovery group was lower than that in the control group (16.00%) (P <0.05). There was no significant difference in the incidence of nausea and vomiting between the observation group and the control group (all P> 0.05). The Apgar scores at 1 and 5 min and the NBNA scores at 1 and 24 h in both groups showed no significant difference (all P> 0.05). Conclusion The preeclampsia cesarean section with 0.5% bupivacaine combined with dexmedetomidine intrathecal injection can significantly improve the anesthetic effect, reduce anesthesia wake awake chills, no significant adverse effects on newborns.