张明阳+韩洋+刘志东+刘伟

摘 要 目的： 观察舒芬太尼联合右美托咪定在急诊剖宫产中对产妇麻醉效果的影响。方法： 硬膜外麻醉下行急诊剖宫产产妇120例，随机分为4组，每组30例。所有产妇均先给予0.75%罗哌卡因15 ml，然后B组再静脉给予舒芬太尼10 μg、C组静脉15 min内泵入右美托咪定0.5 μg/kg、D组静脉给予舒芬太尼10 μg联合静脉15 min内泵入右美托咪定0.5 μg/kg。术中连续监测产妇循环呼吸状况，观察不良反应和新生儿的情况。结果：B组、D组胎儿取出前镇痛效果优于A组（P<0. 05）；C组、D组焦虑评分低于A组（P<0. 05）；C组、D组生命体征波动小于A组，且恶心、呕吐、低血压、寒战发生率低于A组（P<0. 05）。结论：在急诊剖宫产硬膜外麻醉中舒芬太尼和右美托咪定静脉联合给药能够增强胎儿取出前镇痛效果，抑制牵拉反应，减少生命体征波动，降低恶心呕吐、低血压、寒战发生率。

关键词 右美托咪定 舒芬太尼 硬膜外麻醉 急诊剖宫产

中图分类号：R614.42； R719.8 文献标识码：A 文章编号：1006-1533（2016）21-0020-03

The anesthesia effects of sufentanil combined with dexmedetomidine on 30 cases of puerperae with emergency caesarean section

ZHANG Mingyang*， HAN Yang， LIU Zhidong， LIU Wei**（Department of Anesthesiology， Tengzhou Central Peoples Hospital， Tengzhou 277500， China）

ABSTRACT Objective： To investigate the anesthesia effects of sufentanil and dexmedetomidine on puerperae undergoing emergency cesarean section. Methods： One hundred and twenty cases of puerperae were randomly divided into four groups with 30 cases each. All the puerperae were first epidurally injected with 0.75% ropivacaine 15 ml， then group B was intravenously given 10 μg of sufentanil， group C was intravenously pumped 0.5 μg/kg of dexmedetomidine within 15 min while group D was given 10 μg of sufentanil combined with 0.5 μg/kg of dexmedetomidine within 15 min. During operations， their circulatory and respiratory conditions were continuously monitored， while the adverse reactions occurred in these women and newborns were observed. Results： The anesthesia effects were better in group B and D than group A. The anxiety scores were lower in group C and D than group A. The fluctuation in vital signs was less in group C and D than in group A. The incidence of nausea， vomiting， hypotension， chill was lower in group C and D than in group A. Conclusion： In the epidural anesthesia of emergency cesarean section， intravenous co-administration of sufentanil and dexmedetomidine can enhance analgesic effects before delivery of baby， inhibit draw reaction， decrease the fluctuation in vital signs and reduce the incidence of adverse reactions such as nausea， vomiting， hypotension and chill.

KEY WORDS dexmedetomidine； sufentanil； epidural anesthesia； emergency cesarean section

急诊剖宫产产妇情绪紧张焦虑，要求麻醉起效迅速且对新生儿无呼吸抑制等不良影响。临床上常用的硬膜外麻醉需要一定的起效时间且产妇有牵拉反应，而全身麻醉对新生儿有呼吸抑制。右美托咪定具有抗焦虑、抑制交感活性、无呼吸抑制、维持生命体征稳定等药理性质[1-3]，但其镇痛作用差。舒芬太尼具有较强的镇痛作用，大剂量有呼吸抑制作用，没有抑制交感活性的作用。已有研究提示右美托咪定联用舒芬太尼能够增强剖宫产术后患者的镇痛效果[4-5]。本研究观察比较右美托咪定和舒芬太尼单独及联合用于急诊剖宫产硬膜外麻醉的效果。

1 资料与方法

1.1 一般资料

经医院伦理委员会同意，在产妇及家属对术中用药知情同意的情况下选择在硬膜外麻醉下行急诊剖宫产的妊娠产妇120例，美国麻醉医师协会（ASA） Ⅰ或Ⅱ级，20～38岁，身高（160.4±4.1）cm，体重（75.5±8.5）kg，排除对药物过敏、胎儿异常、心血管疾病、精神、神经系统疾病等病史者。……