不同剂量鞘内注射右美托咪定作为佐剂联合高压布比卡因在剖宫产患者中的效果。

Effect of Different Doses of Intrathecal Dexmedetomidine as an Adjuvant Combined With Hyperbaric Ropivacaine in Patients Undergoing Cesarean Section.

作者信息

Bi Yong-Hong, Wu Jia-Min, Zhang Yan-Zhuo, Zhang Rui-Qin

机构信息

Department of Anesthesiology, China and Heilongjiang Key Laboratory for Anesthesia and Critical Care, The Second Affiliated Hospital of Harbin Medical University, Harbin, China.

出版信息

Front Pharmacol. 2020 Mar 20;11:342. doi: 10.3389/fphar.2020.00342. eCollection 2020.

OBJECTIVE

In this study, we aim to investigate the effect of different doses of dexmedetomidine as an adjuvant to hyperbaric ropivacaine in spinal anesthesia for cesarean section.

METHODS

Seventy-five parturients with American Society of Anesthesiologists (ASA) I or II were anesthetized with intrathecal ropivacaine (12.5 mg) alone (R group) or in combination with dexmedetomidine 3 μg (RD3 group) and 5 μg (RD5 group) to undergo a cesarean section. The anesthetic parameters, postoperative analgesia, stress responses and neonates outcomes were monitored.

RESULTS

The onset time of sensory block to T10, T4, and peak level in the RD3 group and RD5 group were significantly shorter than those in the R group (p < 0.05). The time of the level of sensory block to descend two segments and to T10 in the RD3 group(57.28 ± 16.65 min, 3.87 ± 1.60 h) and RD5 group (71.92 ± 10.10 min, 3.99 ± 1.06 h) were longer than that in the R group (40.64 ± 12.06 min, 1.98 ± 1.01 h) (p < 0.05). The median time of motor blockade to both legs score 3 on the Bromage scale (B3B3) in the RD3 group and RD5 group was shorter than that in the R group (p < 0.001). The time of motor blockade recovery to both legs score 0 on the Bromage scale (B0B0) in the RD5 group (3.6 h) was longer than that in the R group (2 h) or RD3 group (2.2 h) (p < 0.001). Visceral traction response and abdominal muscle relaxation during the operation in the RD3 group and the RD5 group were better than that in the R group. The Visual Analogue Score (VAS) in the 12 h after the operation in the RD3 group (3.30 ± 1.17) and RD5 group (2.80 ± 0.87) was smaller than that in the R group (3.80 ± 1.47) (p < 0.05). The incidence of shivering in the RD3 group and RD5 group was significantly lower than that in the R group (p < 0.05). The postoperative concentrations of c-reactive protein (CRP), interleukin-6 (IL-6) and cortisol in the RD3 and RD5 groups were lower than that in the R group (p < 0.05).

CONCLUSION

3 µg intrathecal dexmedetomidine as an adjuvant to ropivacaine improved intraoperative somato-visceral sensory block characteristics and postoperative analgesia, alleviated shivering in parturients, and did not prolong the time of motor block or produce any side effects, which makes this dose appropriate for cesarean delivery.

CINICAL TRIAL REGISTRATION

ChiCTR, identifier ChiCTR1800014454. Registered 15 January 2018, http://www.chictr.org.cn/edit.aspx?pid=24613&htm=4.

目的

在本研究中，我们旨在探讨不同剂量右美托咪定作为剖宫产腰麻中罗哌卡因辅助用药的效果。

方法

75例美国麻醉医师协会（ASA）分级为I或II级的产妇，分别接受单纯鞘内注射罗哌卡因（12.5mg）（R组），或联合3μg右美托咪定（RD3组）及5μg右美托咪定（RD5组）进行剖宫产麻醉。监测麻醉参数、术后镇痛、应激反应及新生儿结局。

结果

RD3组和RD5组感觉阻滞至T10、T4的起效时间及最高平面显著短于R组（p<0.05）。RD3组（57.28±16.65分钟，3.87±1.60小时）和RD5组（71.92±10.10分钟，3.99±1.06小时）感觉阻滞平面下降两个节段至T10的时间长于R组（40.64±12.06分钟，1.98±1.01小时）（p<0.05）。RD3组和RD5组布罗玛杰分级法（Bromage scale）双下肢运动阻滞评分达3分（B3B3）的中位时间短于R组（p<０.001）。RD5组双下肢运动阻滞恢复至布罗玛杰分级法评分0分（B0B0）的时间（3.6小时）长于R组（2小时）或RD3组（2.2小时）（p<0.001）。RD3组和RD5组术中内脏牵拉反应及腹肌松弛情况优于R组。RD3组（3.30±1.17）和RD5组（2.80±0.87）术后12小时的视觉模拟评分（VAS）低于R组（3.80±1.47）（p<0.05）。RD3组和RD5组寒战发生率显著低于R组（p<0.05）。RD3组和RD5组术后c反应蛋白（CRP）、白细胞介素-6（IL-6）及皮质醇浓度低于R组（p<0.05）。