剖宫产全身麻醉期间右美托咪定与瑞芬太尼对母亲和新生儿的影响。
Effects of dexmedetomidine versus remifentanil on mothers and neonates during cesarean section under general anesthesia.
作者信息
Yu Zhiqiang, Zhang Peijun, Wang Haiyun, Zhang Li, Wei Wei, Fang Wenqian, Mu Xingbo
机构信息
Department of Anesthesiology, The Third Central Clinical College of Tianjin Medical University, Tianjin Third Central Hospital, Nankai University Affinity the Third Central Hospital, Tianjin Institute of Hepatobiliary Disease, Tianjin Key Laboratory of Extracorporeal Life Support for Critical Diseases, Tianjin 300170, China.
Department of Anesthesiology, Central Hospital of gynecology and obstetrics, Tianjin 300100, China.
出版信息
Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2020 Dec;164(4):417-424. doi: 10.5507/bp.2019.055. Epub 2019 Nov 19.
BACKGROUND AND AIMS
Dexmedetomidine and remifentanil use in obstetric general anesthesia is controversial. This study aimed to compare the effects of remifentanil and dexmedetomidine on mothers and neonates during cesarean section under general anesthesia.
METHODS
A total of 120 patients scheduled for elective cesarean section under general anesthesia were randomly allocated to dexmedetomidine (D), remifentanil (R), and control (C) groups. Anesthesia was induced with propofol and muscle relaxants in all groups. Anesthesia in groups D and R was induced with dexmedetomidine (induction, 0.5 µg/kg; maintenance, 0.5 µg/kg.h) and remifentanil (induction, 0.5 µg/kg; maintenance, 2 µg/kg.h), respectively, until birth. Group C received equivalent volumes of normal saline. Mean arterial blood pressure (MAP), heart rate (HR), plasma catecholamine, visual analog pain score (VAS), and total tramadol consumption at 1, 2, and 3 hours after extubation were recorded. Neonatal effects were assessed by Apgar scores and umbilical blood gas analysis.
RESULTS
Post induction, MAP was significantly higher in group D compared to groups C and R, and significantly lower in group R than in group C. At intubation/skin incision and delivery, MAP, HR, and plasma epinephrine and norepinephrine concentrations were significantly lower in groups D and R than in group C. Compared to group R, MAP was significantly higher, and HR, plasma epinephrine, and norepinephrine concentrations were significantly lower in group D. Compared with groups C and D, the percentage of neonates with Apgar score < 7 was higher in group R at 1 min after delivery. Compared with groups C and R, the VAS was significantly lower in group D at 1 and 2 h postoperatively. Total tramadol consumption was significantly lower in group D at 3 hours postoperatively.
CONCLUSION
During general anesthesia for cesarean section, remifentanil demonstrated better control of hemodynamic stability, while dexmedetomidine demonstrated better neonatal Apgar scores, postoperative analgesia, and decreased catecholamine release.
TRIAL REGISTRATION
Chinese Clinical Trial Register (ChiCTR) - ChiCTR1800017125.
背景与目的
右美托咪定和瑞芬太尼用于产科全身麻醉存在争议。本研究旨在比较瑞芬太尼和右美托咪定在全身麻醉剖宫产术中对母亲和新生儿的影响。
方法
总共120例计划在全身麻醉下行择期剖宫产的患者被随机分配至右美托咪定组（D组）、瑞芬太尼组（R组）和对照组（C组）。所有组均用丙泊酚和肌肉松弛剂诱导麻醉。D组和R组分别用右美托咪定（诱导剂量，0.5μg/kg；维持剂量，0.5μg/kg·h）和瑞芬太尼（诱导剂量，0.5μg/kg；维持剂量，2μg/kg·h）诱导麻醉，直至胎儿娩出。C组输注等量生理盐水。记录拔管后1小时、2小时和3小时的平均动脉血压（MAP）、心率（HR）、血浆儿茶酚胺、视觉模拟疼痛评分（VAS）以及曲马多总用量。通过阿氏评分和脐血气分析评估新生儿情况。
结果
诱导后，D组的MAP显著高于C组和R组，R组的MAP显著低于C组。在气管插管/皮肤切开和胎儿娩出时，D组和R组的MAP、HR以及血浆肾上腺素和去甲肾上腺素浓度显著低于C组。与R组相比，D组的MAP显著更高，HR、血浆肾上腺素和去甲肾上腺素浓度显著更低。与C组和D组相比，R组在胎儿娩出后1分钟时阿氏评分<7分的新生儿百分比更高。与C组和R组相比，D组在术后1小时和2小时时的VAS显著更低。术后3小时，D组的曲马多总用量显著更低。
结论
在剖宫产全身麻醉期间，瑞芬太尼对血流动力学稳定性的控制更佳，而右美托咪定则在新生儿阿氏评分、术后镇痛以及减少儿茶酚胺释放方面表现更佳。
试验注册
中国临床试验注册中心（ChiCTR）- ChiCTR1800017125
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