梁俏丽 叶君 周结贤

【摘要】 目的：探讨右美托咪定在剖宫产中的应用价值。方法：选取2019年8月-2020年4月本院剖宫产产妇200例，根据麻醉方法分为观察组（n=102）和对照组（n=98），观察组静脉给予右美托咪定并复合罗哌卡因蛛网膜下腔麻醉，对照组给予罗哌卡因蛛网膜下腔麻醉。比较两组术中Ramsay镇静评分、Wrench分级以及牵拉反应。比较两组新生儿脐静脉血皮质醇（Cor）与一氧化氮（NO）。结果：观察组Ramsay镇静评分优于对照组（P<0.05）;观察组Wrench分级、牵拉反应均明显弱于对照组（P<0.05）;观察组新生儿脐静脉Cor明显低于对照组新生儿，而NO明显高于对照组新生儿（P<0.05）。结论：右美托咪定在剖宫产术中具有一定的应用价值，可减轻寒战及牵拉反应的发生。

【关键词】 右美托咪定 剖宫产术 寒战 牵拉反应

Application Value of Dexmedetomidine in Cesarean Section/LIANG Qiaoli， YE Jun， ZHOU Jiexian. //Medical Innovation of China， 2021， 18（31）： -175

[Abstract] Objective： To explore the application value of Dexmedetomidine in cesarean section. Method： A total of 200 cases of cesarean delivery in our hospital were selected from August 2019 to April 2020， and they were divided into observation group （n=102） and control group （n=98） according to the anesthesia method. The observation group was given Dexmedetomidine intravenously combined with subarachnoid anesthesia with Ropivacaine， and the control group was given subarachnoid anesthesia with combined with Ropivacaine. The intraoperative Ramsay sedation score， Wrench grading and stretch reaction were compared between the two groups. Umbilical venous blood cortisol （Cor） and nitric oxide （NO） of newborns were compared between the two groups. Result： The Ramsay sedation score of observation group was better than that of control group （P<0.05）; the Wrench grading and stretch reaction in the observation group were significantly weaker than those in the control group （P<0.05）; the Cor of umbilical vein blood of newborn in the observation group was significantly lower than that of newborn in the control group， while the nitric oxide （NO） was significantly higher than that of newborn in the control group （P<0.05）. Conclusion： Dexmedetomidine has certain application value in cesarean section， which can reduce the occurrence of shivering and stretch reaction.

[Key words] Dexmedetomidine Cesarean section Shiver Stretch reaction

First-author’s address： Zhuhai Maternal and Child Health Hospital， Zhuhai 519000， China

doi：10.3969/j.issn.1674-4985.2021.31.041

剖宮产手术是临床处理难产、高危妊娠的常用方法，蛛网膜下腔麻醉是剖宫产常用的麻醉方法，对胎儿影响较小。为预防蛛网膜下腔阻滞平面过高造成孕妇呼吸循环抑制，通常选择阻滞平面控制在胸8以下。但阻滞平面过低术中阻滞效果欠完善，术中可发生牵拉反应[1]。罗哌卡因是蛛网膜下腔麻醉常用的长效酰胺类局部麻醉药物，可引起麻醉区域血管扩张、有效循环减少，体温调节中枢出现对热量散失产生代偿反应而发生寒战[2]。寒战反应会牵拉手术切口，加重疼痛反应，同时也会加重产妇的不良情绪，应给予积极的预防和治疗[3]。右美托咪定是一种高度选择性α2受体激动剂，具有镇静、镇痛、抗交感等多种药理作用[4]。……