目的：探讨剖宫产手术麻醉中使用右美托咪定的镇静效果以及对新生儿的Apgar评分的影响。方法选择广东省云浮市人民医院腰硬联合麻醉行剖宫产手术的孕妇240例，将其随机分为四组，每组60例，右美托咪定三组(A、B、C组)；生理盐水对照组(D组)。麻醉操作前A、B、C三组分别开始以微泵持续泵入右美托咪定0.6、0.8、1μg/kg，时间设定为15 min；D组注射相同剂量的生理盐水，四组孕妇均于L3~L4间隙行腰硬联合麻醉，于注药前(T0)、注药后10 min(T1)、注药后20 min(T2)、注药后30 min(T3)对孕妇进行Ramsay镇静水平评分，于T0和T2进行焦虑视觉类比试验(AVAT)和状态焦虑问卷测试(SAI)并记录，连续监测HR、SpO2、MAP，并记录T0、T1、T2、T3时的测定值，比较各组新生儿1、5、10 min的Apgar评分。结果 A、B、C三组孕妇T2时AVAT值[(23.7±11.8)、(22.1±12.3)、(23.5±11.7)]明显低于T0[(39.8±17.1)、(42.5±18.3)、(40.7±17.7)]，差异均有统计学意义(P<0.05)；A、B、C三组孕妇T2时SAI值[(33.6±6.8)、(31.1±6.5)、(30.4±6.7)]明显低于T0[(41.3±7.5)、(42.2±8.1)、(42.4±7.6)]，差异均有统计学意义(P<0.05)；A、B、C三组T1、T2时Ramsay评分[A组：(2.6±0.2)、(2.8±0.3)分；B组：(3.4±0.5)、(3.5±0.8)分；C组：(3.5±0.8)、(4.7±0.6)分]明显高于T0[(1.5±0.5)、(1.6±0.5)、(1.5±0.5)分]，差异均有统计学意义(P<0.05)；与A、B、C三组T2时的HR较T0时明显下降(P<0.05)；A组的MAP在T0~T2时段平稳，而T2时B、C两组的MAP较T0明显降低，D组T1和T2时的MAP、HR与T0时比较，MAP明显下降，心率明显增快，差异均有统计学意义(P<0.05)，四组孕妇的新生儿出生后1、5、10 min时的Apgar评分组间比较差异无统计学意义(P>0.05)。结论剖宫产手术麻醉中使用右美托咪定能对孕妇产生镇静效应，对新生儿Apgar评分无影响，且使用0.6μg/kg剂量的右美托咪定的孕妇镇静水平适当，血流动力学最为稳定，值得推荐使用。%Objective To investigate the sedative effect of Dexmedetomidine in cesarean section and affect the new-born's Apgar score. Methods 240 cases of pregnant women with caesarean section under combined spinal-epidural anesthesia in the People's Hospital of Yunfu City were selected, they were randomly divided into four groups, with 60 cases in each group, three Dexmedetomidine groups (group A, B, C); saline control group (group D), before anesthesia groups A, B, C were given the 0.6, 0.8, 1 μg/kg Dexmedetomidine micropump continuous infusion respectively, time was set for 15 minutes; group D were injected with the same dose of saline, pregnant women of four groups were given the epidural anesthesia injection at L3-L4 interspace. Pregnant women were given Ramsay sedation level score before injection (T0) recorded 10 min after injection (T1), 20 min after injection (T2) , 30 min after injection (T3); and the anxi-ety visual analog test (AVAT); state anxiety inventory test (SAI) were carried out and recorded at T0, T2; continuous monitoring of HR, SpO2, MAP and the value at T0, T1, T2, T3 were recorded. The newborn Apgar score at 1, 5 min and 10 min after birth of four groups were compared. Results AVAT value of group A, B, C at T2 [(23.7±11.8), (22.1±12.3), (23.5±11.7)] were significantly lower than T0 [(39.8±17.1), (42.5±18.3), (40.7±17.7)], the differences were statistically significant (P<0.05);SAI value of group A, B, C at T2 [(33.6±6.8), (31.1±6.5), (30.4±6.7)] were significantly lower than T0 [(41.3±7.5), (42.2±8.1), (42.4±7.6)], the differences were statistically significant (P<0.05);Ramsay score of group A, B, C at T1, T2 [group A: (2.6±0.2), (2.8±0.3) points;group B: (3.4±0.5), (3.5±0.8) points; group C: (3.5±0.8), (4.7±0.6) points] were significantly higher than T0 [(1.5±0.5), (1.6±0.5), (1.5±0.5) points], the differences were statisti-cally significant (P<0.05);compared with T2, the HR of group A, B, C at T0 were decreased significantly (P<0.05);MAP of group A at T0, T2 were stable, while group B, C at T2 were significantly lower than T0, compared with T0, MAP and HR of group D at T1 and T2 were decreased significantly, heart rate were significantly increased, and the differences were statistically significant (P<0.05). The newborn Apgar score at 1, 5 min and 10 min after birth in four groups had no statistically significant difference (P>0.05). Conclusion Cesarean section anesthesia using dexmedetomidine capital in pregnant women can produce sedative effect, no effect on the Apgar score, and 0.6 μg/kg dose dexmedetomidine se-dation given the appropriate level of maternal blood most stable hemodynamics, it is recommended to use.
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