目的：探讨子痫前期行剖宫产分娩时右美托咪定应用对麻醉效果及安全性。方法以西安市北方医院近期收治子痫前期行剖宫产分娩的产妇120例作为研究对象，随机分为右美托咪定组（60例）和对照组（60例），分别于腰麻后行生理盐水和右美托咪定鞘内注射，比较两组产妇不同时间点血流动力学指标，手术结束时Ramsay镇静评分，阻滞起效、维持时间及围手术期不良反应发生情况等。结果两组产妇在T0（tSBP ＝1．04，tDBP ＝0．73，tHR ＝0．94），T1（tSBP ＝1．18，tDBP ＝1．33，tHR ＝0．82），T2（tSBP ＝1．25，tDBP ＝1．10，tHR ＝1．21），T3（tSBP ＝0．95，tDBP ＝1．42，tHR ＝1．24），T4（tSBP ＝0．97，tDBP ＝0．63，tHR ＝1．07）等5个不同时间点血流动力学指标组间比较差异无统计学意义（P＞0．05）；右美托咪定组产妇手术结束时Ramsay镇静评分显著高于对照组，差异有统计学意义（t＝2．14，P＜0．05）；右美托咪定组产妇阻滞起效时间和维持时间均显著优于对照组，差异有统计学意义（t值分别为2．40，2．77，2．19，2．52，P＜0．05）；右美托咪定组产妇寒颤和牵拉反应发生率显著低于对照组，差异有统计学意义（χ2值分别为13．14，20．67，P＜0．05）。结论子痫前期行剖宫产分娩产妇腰麻后右美托咪定应用可显著改善麻醉效果，降低围手术期寒颤和牵拉反应发生风险。%Objective To explore the anesthetic effect and safety of dexmedetomidine on lying-in women with preeclampsia undergoing cesarean section .Methods A total of 120 lying-in women with preeclampsia recently hospitalized at Xi ’ an North Hospital and undergoing cesarean section were chosen as research objects .They were randomly divided into dexmedetomidine group ( n=60 ) and control group (n=60).After undergoing spinal anesthesia , dexmedetomidine group received intrathecal injection of dexmedetomidine and control group received saline injection respectively .Hemodynamics indexes of lying-in women at different time points , Ramsay sedation scale at the end of surgery , the onset time and duration of sensory block , and the incidence of adverse reaction during perioperative period were compared between two groups .Results There was no statistical difference in hemodynamic indexes at five different time points between two groups (all P>0.05), namely T0(tSBP =1.04, tDBP=0.73, tHR=0.94), T1(tSBP =1.18, tDBP =1.33, tHR =0.82), T2(tSBP =1.25, tDBP =1.10, tHR =1.21), T3(tSBP =0.95, tDBP =1.42, tHR =1.24), and T4(tSBP =0.97, tDBP =0.63, tHR =1.07).The Ramsay sedation score at the end of operation of dexmedetomidine group was significantly higher than that of the control group (t=2.14, P<0.05).The dexmedetomidine group exceeded the control group in the onset time and duration time of sensory block , and the differences were of statistical difference (t value was 2.40, 2.77, 2.19 and 2.52, respectively, all P<0.05).Lying-in women at the dexmedetomidine group had significantly lower incidence rate of shivering and traction reaction than the control group , and the differences were statistically significant (χ2 value was 13.14 and 20.67, respectively, both P <0.05).Conclusion Dexmedetomidine can significantly improve anesthetic effect when used after lumbar anesthesia on lying-in women with preeclampsia undergoing cesarean section , and reduce the risk of shivering and traction reaction in perioperative period .
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