椎管内麻醉剖宫产术中应用右美托咪定对胃肠功能恢复的影响：一项随机、双盲、安慰剂对照临床试验。

Effect of intraoperative dexmedetomidine on recovery of gastrointestinal function after caesarean section undergoing spinal and epidural anesthesia: A randomized, double blind, placebo-controlled clinical trial.

机构信息

Department of Anesthesiology, The First Affiliated Hospital of Anhui Medical University, Hefei, China.

出版信息

Eur J Obstet Gynecol Reprod Biol. 2024 Jun;297:30-35. doi: 10.1016/j.ejogrb.2024.03.038. Epub 2024 Mar 30.

DOI:10.1016/j.ejogrb.2024.03.038

Abstract

OBJECTIVE

Gastrointestinal dysfunction after cesarean section negatively affects postoperative recovery. Dexmedetomidine has been shown to improve postoperative gastrointestinal function in patients undergoing lumbar spinal fusion surgery and laparoscopic gastrectomy, but its role in cesarean section has not been fully elucidated. The study aimed to investigate the effect of dexmedetomidine on gastrointestinal function after cesarean section.

STUDY DESIGN

220 pregnant women who underwent elective cesarean section were randomized into group D and group S. Group D patients received a loading dose of 0.5 μg/kg of dexmedetomidine for 10 mins followed by a maintenance dose of 0.5 μg/kg/h intravenously immediately after the umbilical cord was cut intraoperatively, whereas the other group (group S) received an equivalent quantity of normal saline as loading and maintenance dose IV by infusion pump. The primary outcome was time to first flatus after surgery (hours). Secondary outcomes included time to first feces and first bowel sounds (hours), incidence rates of postoperative gastrointestinal complications, and the length of postoperative hospital stay (days).

RESULTS

Modified intention-to-treat analysis showed that patients in Group D had a significantly shorter time to first flatus (21 [16 to 28.25] vs. 25 [18 to 32.25] h; P = 0.014), time to first feces (45.5 [35.75 to 55.25] vs. 53 [40 to 60] h; P = 0.019), and time to first bowel sounds (P = 0.010), a lower incidence of abdominal distension (21[20.6 %] vs. 36[34.3 %], P = 0.027), shorter length of postoperative hospital stay (P = 0.010) compared to patients in Group S.

CONCLUSION

Intraoperative dexmedetomidine infusion reduces the time to first flatus, the incidence of abdominal distension, and shortens the length of hospital stay, promoting gastrointestinal function after cesarean section.

摘要

目的

剖宫产术后胃肠道功能障碍会影响术后恢复。右美托咪定已被证明可改善腰椎融合术和腹腔镜胃切除术患者的术后胃肠道功能，但在剖宫产中的作用尚未完全阐明。本研究旨在探讨右美托咪定对剖宫产术后胃肠道功能的影响。

研究设计

220 例行择期剖宫产的孕妇随机分为 D 组和 S 组。D 组患者在术中脐带剪断后立即静脉输注 0.5μg/kg 的右美托咪定负荷剂量 10 分钟，然后以 0.5μg/kg/h 的速度维持静脉输注；而另一组（S 组）以输液泵输注等容量的生理盐水作为负荷量和维持量。主要结局是术后首次肛门排气时间（小时）。次要结局包括首次排便和首次肠鸣音时间（小时）、术后胃肠道并发症发生率和术后住院时间（天）。

结果

意向治疗分析显示，D 组患者首次肛门排气时间（21[16 至 28.25]比 25[18 至 32.25]h；P=0.014）、首次排便时间（45.5[35.75 至 55.25]比 53[40 至 60]h；P=0.019）和首次肠鸣音时间（P=0.010）明显缩短，腹胀发生率（21[20.6%]比 36[34.3%]，P=0.027）降低，术后住院时间（P=0.010）缩短。