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| 右美托咪定复合布托啡诺预防卡前列素氨丁三醇不良反应的效果 |
| Comparison of the effect of dexmedetomidine combined with butorphanol to prevent the adverse effects of carboprost tromethamine druing cesarean delivery |
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| DOI：10.12089/jca.2018.03.010 |
| 中文关键词: 剖宫产 右美托咪定 布托啡诺 卡前列素氨丁三醇 不良反应 |
| 英文关键词: Cesarean delivery Dexmedetomidine Butorphanol Carboprost tromethamine Adverse effects |
| 基金项目:揭阳市卫生医疗科技项目（2017YL020） |
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| 中文摘要: |
| 目的 比较剖宫产术中右美托咪定复合布托啡诺预防卡前列素氨丁三醇不良反应的效果。方法 选择择期行足月剖宫产术, 且存在宫缩乏力危险因素的产妇90例, 年龄24～40岁,体重55～85 kg，ASA Ⅰ或Ⅱ级。将患者随机分为右美托咪定+布托啡诺组(DB组)、布托啡诺组(B组)和对照组(N组), 每组30例。三组产妇在子宫体注射卡前列素氨丁三醇时分别静脉给予相应药物, DB组静脉注射布托啡诺20 μg/kg, 同时持续泵注右美托咪定1 μg/kg, 10 min后改右美托咪定0.3 μg·kg-1·min-1持续静脉泵注至术毕;B组静脉注射布托啡诺20 μg/kg;N组静脉泵注生理盐水。记录入室静卧10 min(基础值，T0)、注射卡前列素氨丁三醇后10 min(T1)、术毕(T2)的MAP、HR和SpO2, 并在T1时进行Ramsay镇静评分。记录注射卡前列素氨丁三醇后恶心、呕吐、胸闷胸痛、高血压、心动过速、寒战的发生情况。记录术后泌乳始动时间。记录术后1、3、5 d子宫底高度。记录术后72 h内缩宫素使用量。结果 与N组比较, T1时DB组、B组MAP明显降低, HR明显减慢(P＜0.05);与B组比较, T1时DB组MAP明显降低, HR明显减慢(P＜0.05)。DB组、B组Ramsay评分明显高于N组(P＜0.05), DB组明显高于B组(P＜0.05)。DB组和B组恶心、呕吐、胸闷胸痛、高血压、心动过速和寒战发生率明显低于N组(P＜0.05), DB组明显低于B组(P＜0.05)。三组术后泌乳始动时间、术后1、3、5 d子宫底高度、术后72 h内缩宫素使用量差异均无统计学意义。结论 右美托咪定复合布托啡诺能有效减少剖宫产术中应用卡前列素氨丁三醇所致的不良反应, 使血流动力学更加平稳且有一定的镇静作用, 效果优于单独应用布托啡诺, 同时不影响泌乳和产褥早期子宫复旧, 可安全有效地用于临床。 |
| 英文摘要: |
| Objective To compare the effect of dexmedetomidine combined with butorphanol to prevent the adverse effects of carboprost tromethamine druing cesarean delivery. Methods Ninety parturients with the risk factor of uterine atony, aged 24-40 years, weighting 55-85 kg, ASA physical status Ⅰ or Ⅱ, undergoing full term cesarean section, were randomly divided into dexmedetomidine combined with butorphanol group (group DB, n=30), butorphanol group (group B, n=30) and control group (group N, n=30). Three groups were intravenously injected corresponding drugs of carboprost tromethamine into uterus. Group DB was given intravenous injection dexmedetomidine 1 μg/kg combined with butorphanol 20 mg/kg. Group B was given butorphanol 20 mg/kg. Group N was given 0.9％ sodium chloride solution. MAP, HR, and SpO2 were recorded at different times, 10 min after go into operation room (T0), 10 min after carboprost tromethamine into uterus (T1), end of operation (T2). Ramsay sedation score was recorded at T1. The adverse effects of carboprost tromethamine were recorded. The initial time of lactation after operation was recorded. The initial time of lactation after operation, the height of uterine fundus at 1, 3, 5 d after operation, the oxytocin doses within 72 h after operation were recorded. Results Compared with group N, the MAP and HR of group DB and group B decreased obviously at T1 (P＜0.05), and group DB was lower than group B obviously at T1 (P＜0.05). Compared with group N, the scores of Ramsay in group DB and group B were significantly higher (P＜0.05), group DB was higher than that of group B (P＜0.05). Compared with group N, the incidence of nausea, vomiting, chest tightness, chest pain, hypertension, tachycardia and chills in group B and group DB were significantly lower (P＜0.05), and group DB was lower than that of group B (P＜0.05). There were no significant differences of the initial time of lactation after operation, height of uterine fundus at 1, 3, 5 d after operation, the oxytoxin doses within 72 h after operation between the three groups. Conclusion Dexmedetomidine combined with butorphanol can effectively reduce the adverse effects of carboprost tromethamine druing cesarean delivery, the more stable hemodynamics and sedative effect, the effect is better than the single application of butorphanol, at the same time does not affect lactation, it is safe and effective for clinical use. |
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