Zhang Qian, Xia Ling-Yi, Liang Wei-Dong, Rao Ding-Yu, Zhu Ping-Ping, Huang Ke-Nv, Deng Zi-Hao, Zhong Mao-Lin
First Clinical Medical College, Gannan Medical University, Ganzhou, China.
Department of Anesthesiology, Nanjing Gulou Hospital Group Suqian Hospital Co., Ltd., Suqian, China.
Front Med (Lausanne). 2022 Jul 7;9:922611. doi: 10.3389/fmed.2022.922611. eCollection 2022.
This study aimed to find the best dose of dexmedetomidine in spinal anesthesia for cesarean section.
120 American Society of Anesthesiologists (ASA) Class I and II parturients undergoing elective cesarean delivery under spinal anesthesia were randomly allocated into four groups treated with intrathecal ropivacaine (12 mg) alone (Group R) or in combination with dexmedetomidine 5 μg (Group RD1), 7.5 μg (Group RD2) and 10 μg (Group RD3). Characteristics of spinal anesthesia, hemodynamic changes, adverse effects, stress reactions and neonatal outcomes were recorded in the four groups.
Patients in Group RD1, RD2, and RD3 had significantly longer sustained sensory and motor block time than patients in Group R. All four groups had comparable onset times of sensory and motor block. The time for the level of sensory block to lower to S1 was longer in Group RD1 (411.07 ± 106.66 min), Group RD2 (397.03 ± 125.39 min) and Group RD3 (468.63 ± 116.43 min) than in Group R (273.60 ± 88.34 min) ( < 0.001). The time to recover from motor block to a Bromage score of IV was longer in Group RD1 (353.60.07 ± 137.28 min), Group RD2 (350.57 ± 118.01 min) and Group RD3 (404.67 ± 112.83 min) than in Group R (232.70 ± 93.29) ( < 0.01). The incidence of chills was significantly lower in the Group RD1, RD2, and RD3 than in the Group R ( < 0.001). There was no significant difference in the incidence of adverse effects such as hypotension, bradycardia, nausea, vomiting, hypoxemia and pruritus in the four groups ( > 0.05). There was no statistically significant visceral traction response or fentanyl use in the four groups ( > 0.05). Phenylephrine dosing was significantly higher in Group RD2 and RD3 than in Group R ( < 0.05), and there was no significant difference in phenylephrine dosing between Group RD1 and Group R ( > 0.05). There were no statistical differences in postnatal Apgar scores (1 min, 5 min after birth) ( > 0.05). The postoperative concentrations of β-endorphin (β-EP), cortisol (Cor) and tumor necrosis factor-α (TNF-α) in the Group RD1, RD2, and RD3 were lower than that in Group R ( < 0.05).
Intrathecal 5μg of dexmedetomidine as an adjuvant to ropivacaine relieved intraoperative chills, did not increase intraoperative and postoperative adverse effects, did not increase the amount of intraoperative vasoconstrictor used, and reduced intraoperative stress reactions as well as prolonged the duration of maternal sensory and motor block, so this dose is appropriate for cesarean section.
[www.chictr.org.cn/], identifier [ChiCTR2200056052].
本研究旨在探寻剖宫产脊髓麻醉中右美托咪定的最佳剂量。
120例美国麻醉医师协会（ASA）分级为I级和II级、接受择期剖宫产脊髓麻醉的产妇被随机分为四组，分别单独接受鞘内注射罗哌卡因（12mg）（R组），或联合5μg右美托咪定（RD1组）、7.5μg右美托咪定（RD2组）和10μg右美托咪定（RD3组）。记录四组的脊髓麻醉特征、血流动力学变化、不良反应、应激反应及新生儿结局。
RD1组、RD2组和RD3组患者的感觉和运动阻滞持续时间显著长于R组。四组的感觉和运动阻滞起效时间相当。RD1组（411.07±106.66分钟）、RD2组（397.03±125.39分钟）和RD3组（468.63±116.43分钟）感觉阻滞平面降至S1的时间长于R组（273.60±88.34分钟）（P<0.001）。RD1组（353.60±137.28分钟）、RD2组（350.57±118.01分钟）和RD3组（404.67±112.83分钟）运动阻滞恢复至布罗麦奇评分IV级的时间长于R组（232.70±93.29分钟）（P<0.01）。RD1组、RD2组和RD3组寒战发生率显著低于R组（P<0.001）。四组低血压、心动过缓、恶心、呕吐、低氧血症和瘙痒等不良反应发生率无显著差异（P>0.05）。四组内脏牵拉反应或芬太尼使用情况无统计学显著差异（P>0.05）。RD2组和RD3组去氧肾上腺素用量显著高于R组（P<0.05），RD1组和R组去氧肾上腺素用量无显著差异（P>0.05）。产后阿氏评分（出生后1分钟、5分钟）无统计学差异（P>0.05）。RD1组、RD2组和RD3组术后β-内啡肽（β-EP）、皮质醇（Cor）和肿瘤坏死因子-α（TNF-α）浓度低于R组（P<0.05）。
鞘内注射5μg右美托咪定作为罗哌卡因的辅助用药可减轻术中寒战，不增加术中和术后不良反应，不增加术中血管收缩剂用量，减轻术中应激反应，并延长产妇感觉和运动阻滞持续时间，因此该剂量适用于剖宫产。
