摘要
目的探索不同剂量右美托咪定对急诊剖宫产产妇术后泌乳的影响,以期为临床治疗提供参考。方法选择2020年6月-2022年5月于广东省汕头市中心医院在椎管内麻醉下行急诊剖宫产的产妇94例为研究对象,按照随机数字表法将研究对象分为对照组(n=24)、低剂量组(n=24)、中剂量组(n=23)、高剂量组(n=23)。胎儿娩出后,给予低、中、高剂量组产妇静脉泵注经生理盐水稀释至15 mL的右美托咪定,剂量分别为0.5μg/kg、0.8μg/kg、1.0μg/kg;对照组产妇予等量生理盐水静脉泵注,各组均于15 min内完成静脉泵注。本研究设置了以下几个时间节点:T1为入手术室时;T2为手术开始时;T3为静脉泵注试验药剂前;T4为静脉泵注试验药剂后;T5为手术结束时;T6为术后24 h;T7为术后72 h。比较4组产妇T1、T5、T6、T7的焦虑自评量表(SAS)评分及泌乳启动时间;比较4组产妇T3、T4、T5的Ramsay评分;比较4组产妇T6、T7视觉模拟评分法(VAS)评分;比较4组产妇术中低氧血症、心动过缓发生情况;比较4组产妇T7内不良反应发生情况。结果低剂量组、中剂量组、高剂量组产妇泌乳启动时间均短于对照组,中、高剂量组产妇短于低剂量组,差异均有统计学意义(P<0.05)。低剂量组、中剂量组、高剂量组产妇T5、T6、T7的SAS评分均低于对照组,中、高剂量组产妇低于低剂量组,差异均有统计学意义(P<0.05)。低剂量组、中剂量组、高剂量组产妇T4的Ramsay评分高于对照组,中、高剂量组产妇高于低剂量组,高剂量组高于中剂量组,差异均有统计学意义(P<0.05)。低剂量组、中剂量组、高剂量组产妇T6、T7的VAS评分低于对照组,差异均有统计学意义(P<0.05)。4组产妇术中、后不良反应发生率比较无明显差异(P>0.05)。结论单剂量0.8μg/kg右美托咪定在初产妇剖宫产中的应用效果显著,可缩短泌乳启动时间,减轻产妇焦虑情绪,安全有效,值得临床推广应用。
Objective This paper aims to investigate the effect of different doses of dexmedetomidine on postoperative lactation in parturients undergoing emergency cesarean section to provide evidence for clinical treatment.Methods A total of 94 parturients who underwent emergency cesarean section under spinal anesthesia in Shantou Central Hospital from June 2020 to May 2022 were selected as the study participants.They were assigned to the control group(n=24),low-dose group(n=24),medium-dose group(n=23),and high-dose group(n=23)following a random number table.After delivery of the fetus,the parturients in the low,medium,and high dose groups were given dexmedetomidine diluted to 15 mL with normal saline by pump at doses of 0.5μg/kg,0.8μg/kg,and 1.0μg/kg,respectively;the parturients in the control group were given the same amount of normal saline by pump.The intravenous pump was completed within 15 min in each group.The following time points were set for this study:T1 was at admission;T2,at the beginning of surgery;T3,before intravenous pump injection of the test agent;T4,after intravenous pump injection of the test agent;T5,at the end of surgery;T6,24 h after surgery;T7,72 h after surgery.The SAS scores of T1,T5,T6,and T7 and the initiation time of lactation were compared among the four groups;the Ramsay scores of T3,T4,and T5 were compared among the four groups;the visual analogue scale(VAS)scores of T6 and T7 were compared among the four groups;and the occurrence of intraoperative hypoxemia and bradycardia was compared among the four groups.The incidence of adverse reactions within T7 was compared among the four groups.Results The onset time of lactation in the low-dose group,medium-dose group,and high-dose group was significantly shorter than that in the control group,and the onset time of lactation in medium-and highdose groups was significantly shorter than that in the low-dose group(P<0.05).The SAS scores of T5,T6,and T7 in the low-dose,medium-dose,and high-dose groups were lower than the control group,and the medium-dose and high-dose groups were lower than those in the low-dose group,with statistical significance(P<0.05).The Ramsay scores of T4 in the low-dose,medium-dose,and high-dose groups were higher than those in the control group,the medium-dose and highdose groups were higher than the low-dose group,and the high-dose group was higher than the medium-dose group,with statistical significance(P<0.05).The VAS scores of T6 and T7 in the low-dose,medium-dose,and high-dose groups were significantly lower than those in the control group(P<0.05).No significant difference was found in the incidence of intraoperative and postoperative adverse reactions among the four groups(P>0.05).Conclusion A single dose of 0.8μg/kg dexmedetomidine is effective in cesarean section for primipara,which can shorten the initiation time of lactation and reduce maternal anxiety,with safety profiles.These advantages hold promise for a wider clinical application.
作者
郑良杰
黄丽衡
陈超
陈艳萍
Zheng Liangjie;Huang Liheng;Chen Chao;Chen Yanping(Department of Anesthesiology,Shantou Central Hospital,Shantou Guangdong 515000,China)
出处
《保健医学研究与实践》
2023年第8期22-25,52,共5页
Health Medicine Research and Practice
基金
广东省科技专项资金(“大专项+任务清单”)项目(210713176903514)
广东省汕头市科技计划项目(汕府科[2021]3号-25)。
关键词
右美托咪定
急诊
剖宫产
泌乳
Dexmedetomidine
Emergency
Cesarean section
Lactation
