剖宫产术中应用右美托咪定对椎管内麻醉期间 寒颤、牵拉反应的预防效果探讨

赵艳东 王青华

[摘要] 目的 探讨剖宫产术中应用右美托咪定对椎管内麻醉期间寒颤、牵拉反应的预防效果。 方法 入选2018年1～10月的剖宫产患者80例，随机分成对照组与观察组，各40例，两组患者在分娩中以剖宫产的方式分娩，并在胎儿剖出之后，对照组给予生理盐水进行静脉滴注，观察组应用右美托咪定静脉滴注，经过不同的干预治疗后比较两组对椎管内麻醉期间寒颤、牵拉反应的预防效果。 结果 观察组的寒颤发生率为12.50%，明显低于对照组的25.00%，差异有统计学意义（P<0.05）。在牵拉反应的预防中，观察组的预防优良率为90.00%，明显高于对照组的77.50%，差异有统计学意义（P<0.05）。观察组与对照组的不良反应发生率分别为7.50%与10.00%，差异无统计学意义（P>0.05）。 结论 剖宫产术中应用右美托咪定可以对椎管内麻醉期间寒颤、牵拉反应起到良好的预防效果，值得在临床中广泛应用。

[关键词] 剖宫产;右美托咪定;椎管内麻醉;寒颤;牵拉反应

[中图分类号] R971          [文献标识码] B          [文章编号] 1673-9701（2019）33-0116-03

[Abstract] Objective To investigate the preventive effect of dexmedetomidine on chills and traction response during spinal anesthesia in cesarean section. Methods Eighty patients who received cesarean section from January to October 2018 were enrolled and randomLy divided into the control group and the observation group， each had 40 cases. Cesarean section was selected as the delivery method in both groups. After the fetuses were born， the control group was given intravenous infusion of saline and the observation group was given intravenous infusion of dexmedetomidine. After different intervention treatment， the preventive effects on chills and traction response during spinal anesthesia were compared between the two groups. Results The incidence of chills in the observation group was 12.50%， which was significantly lower than the 25.00% in the control group， with statistically significant difference（P<0.05）. In the prevention of traction response， the excellent and good rate of prevention in the observation group was 90.00%， which was significantly higher than the 77.50% of the control group， with statistically significant difference（P<0.05）. The incidences of adverse reactions in the observation group and the control group were 7.50% and 10.00%， respectively， with no statistically significant difference（P>0.05）. Conclusion The use of dexmedetomidine in cesarean section shows a good preventive effect on chills and traction response during spinal anesthesia， which is worthy of wide clinical application.

[Key words] Cesarean section; Dexmedetomidine; Spinal anesthesia; Chills; Traction response

分娩是胎兒自母体离开而独立的过程，是终止妊娠的生理过程，分娩时产妇可以通过产道自然分娩出胎儿，也可经腹部切开子宫将胎儿分娩出，即在临床中分娩方式包括自然分娩和剖宫产分娩，虽然自然分娩为有利于胎儿和母体的分娩方式，但是在临床中剖宫产同时占有较高的比例[1]。特别是随着营养水平的提高，胎儿过大的比例在不断增加，进而剖宫产在临床中的应用率不断增加，剖宫产手术前麻醉一般采取腰椎管内的麻醉，麻醉后患者出现寒颤;牵拉反应等并发症的情况较多，患者会出现寒颤，肌肉紧张，牵拉疼痛等，容易增加机体的耗氧量，影响自身的代谢反应，在手术中出现寒颤直接影响产妇和胎儿的健康，同时寒颤和牵拉反应的发生对术后的身体恢复造成一定的不良影响，给患者的心理带来负面的影响，容易增加产后抑郁的发生比例[2-3]。因此，有效的预防剖宫产患者椎管内麻醉期间寒颤、牵拉反应很有必要。本研究在剖宫产术中应用右美托咪定对椎管内麻醉期间寒颤、牵拉反应进行预防的效果比较突出，现报道如下。