右美托咪定与丙泊酚用于子痫前期产妇剖宫产手术术中镇静的比较

Comparison of Dexmedetomidine and Propofol for Sedation of Preeclampsia Puerperae in Caesarean Section

关键词:  右美托咪定  丙泊酚  子痫前期  剖宫产  镇静

Key words:  dexmedetomidine  propofol  preeclampsia  caesarean section  sedation

摘要:

目的 比较右美托咪定与丙泊酚用于子痫前期患者剖宫产手术术中镇静的有效性和安全性。方法 腰硬联合麻醉下行择期剖宫产手术的子痫前期患者90例，随机均分为右美托咪定组、丙泊酚组及对照组，各组按预定方法分别给予药物。记录患者入室时(T₀)、CSEA给药前(T₁)、切皮时(T₂)、清理腹腔时(T₃)及手术结束时(T₄)的平均动脉压(mean arterial pressure，MAP)、心率(heart rate，HR)、脉搏血氧饱和度(oxygen saturation，SpO₂)、警觉-镇静(observer’s assessment of alertness/sedation，OAA/S)评分，记录新生儿Apgar评分及各组不良反应发生情况。结果 MAP、HR及OAA/S T_1-4右美托咪定组及丙泊酚组均低于对照组，MAP T_1-4，HR T₁、T₃及T₄及OAA/S T₄右美托咪定组低于丙泊酚组(P<0.05)。新生儿Apgar 评分，3组组间比较差异无统计学意义。恶心呕吐、牵拉痛及寒战发生率右美托咪定组及丙泊酚组均低于对照组(P<0.05)；低血压及心动过缓发生率右美托咪定组及丙泊酚组略高于对照组，呼吸抑制及躁动发生率右美托咪定组低于丙泊酚组，但差异均无统计学意义。结论 右美托咪定和丙泊酚均可安全有效地应用于子痫前期患者剖宫产术中镇静，比较而言，右美托咪定镇静后可唤醒，血流动力学更平稳，呼吸抑制等不良反应更少。

Abstract:

OBJECTIVE To compare the efficacy and safety of dexmedetomidine and propofol for sedation of preeclampsia parturient in caesarean section. METHODS Ninety preeclampsia parturient scheduled for caesarean section under combined spinal-epidural anesthesia (CSEA) were randomly divided into 3 groups (n=30), dexmedetomidine group, propofol group and control group, corresponding drugs were infused in three groups with predetermined method. mean arterial pressure(MAP), heart rate(HR), oxygen saturation(SpO₂), observer’s assessment of alertness/sedation(OAA/S) score were recorded when the patients entered the operating room (T₀), before local anesthetics were given (T₁), cutting skin (T₂), cleaning the abdominal cavity(T₃), and end the operation(T₄). Apgar score and the adverse events were recorded too. RESULTS MAP, HR and OAA/S T_1-4 in dexmedetomidine group and propofol group were significantly lower than control group (P<0.05). MAP T_1-4, HR T_1,3,4 and OAA/S T₄ in dexmedetomidine group were significantly lower in propofol group (P<0.05).There was no significant differences in Apgar score among three groups. The rate of nausea and vomiting, referred pain and shivering in dexmedetomidine group and propofol group were significantly lower than that in control group (P<0.05). There were no significant differences the rate of hypotension and bradycardia and respiratory depression and restlessness in three groups. CONCLUSION Both the dexmedetomidine and propofol are safe and effective for the sedation of preeclampsia parturient in caesarean section, but the dexmedetomidine can offer conscious sedation and more stable hemodynamic and less adverse events.