摘要
目的探讨右美托咪定联合利多卡因腰硬联合麻醉对剖宫产产妇术后血流动力学及应激反应的影响。方法回顾性分析洛阳市东方人民医院行腰硬联合麻醉的剖宫产产妇临床资料,根据纳入、排除标准最终筛选出研究对象84例,按麻醉方案分为对照组(n=42)、观察组(n=42)。两组均行腰硬联合麻醉,其中对照组采取0.9%氯化钠注射液+利多卡因麻醉方案,观察组采取右美托咪定+利多卡因麻醉方案。以术后6、12、24 h为时间节点,比较两组疼痛程度、镇静效果。以术前(T1)、给药后10 min(T2)、给药后15 min(T3)为时间节点,比较两组血流动力学指标(心率、平均动脉压)水平。比较两组术前、术后24 h凝血功能指标[活化部分凝血活酶时间(APTT)、纤维蛋白原(FBG)、凝血酶原时间(PT)]、应激反应指标[丙二醛(MDA)、皮质醇(COR)、内皮素(ET)]水平。比较两组术后24 h的恢复质量及围术期不良反应发生率。结果观察组术后24 h内VAS评分低于对照组(P<0.05);观察组术后24 h内Ramsay镇静评分高于对照组(P<0.05);观察组T2-T3时心率、平均动脉压水平波动幅度小于对照组(P<0.05);观察组术后24 h APTT、PT水平均低于对照组,FBG水平高于对照组(P<0.05);观察组术后24 h MDA、COR、ET水平低于对照组(P<0.05);观察组术后24 h QOR-40评分高于对照组(P<0.05);观察组不良反应总发生率为9.52%(4/42),与对照组7.14%(3/42)相比,差异无统计学意义(P>0.05)。结论右美托咪定联合利多卡因行腰硬联合麻醉可提高麻醉质量,缓解剖宫产患者术后疼痛,减轻应激反应损伤,维持血流动力学、凝血功能稳定,且安全可靠,有利于提高术后恢复质量。
Objective To investigate the effects of Dexmedetomidine combined with Lidocaine on hemodynamics and stress response after cesarean section.Methods Clinical data of parturients who received combined epidural and lumbar anesthesia in Luoyang Dongfang People's Hospital from May 2021 to June 2023 were retrospectively analyzed.84 subjects were finally selected according to inclusion and exclusion criteria,and were divided into control group(n=42)and observation group(n=42)according to the anesthetic regimen.Both groups were given combined epidural anesthesia.The control group was given 0.9%sodium chloride injection plus Lidocaine,and the observation group was given Dexmedetomidine plus Lidocaine.The pain levels and sedation effects were compared between the two groups at time points of 6,12,and 24 hours after surgery.The hemodynamic parameters(heart rate and mean arterial pressure)were compared between the two groups at time points of pre-operation(T1),10 minutes after administration(T2),and 15 minutes after administration(T3).The coagulation function indicators[activated partial thromboplastin time(APTT),fibrinogen(FBG),prothrombin time(PT)]and stress response indicators[malondialdehyde(MDA),cortisol(COR),endothelin(ET)]were compared between the two groups at pre-operation and 24 hours after surgery.The recovery quality and perioperative adverse reaction rate were compared between the two groups at 24 hours after surgery.Results The VAS scores in the observation group were lower than those in the control group within 24 hours after surgery(P<0.05).The Ramsay sedation scores in the observation group were higher than those in the control group within 24 hours after surgery(P<0.05).The fluctuation amplitude of heart rate and mean arterial pressure levels in the observation group at T2-T3 was lower than that in the control group(P<0.05).The APTT and PT levels in the observation group were lower than those in the control group,while the FBG level was higher than that in the control group within 24 hours after surgery(P<0.05).The MDA,COR,and ET levels in the observation group were lower than those in the control group within 24 hours after surgery(P<0.05).The QOR-40 score 24 h after operation in the observation group was higher than that in the control group(P<0.05).The total incidence of adverse reactions in the observation group was 9.52%(4/42),compared with 7.14%(3/42)in the control group,the difference was not statistically significant(P>0.05).Conclusion Dexmedetomidine combined with Lidocaine for combined spinal epidural anesthesia can improve the quality of anesthesia,alleviate postoperative pain in patients undergoing cesarean section,reduce stress reaction damage,maintain stable hemodynamic and coagulation function,and is safe and reliable,which is beneficial to improving postoperative recovery quality.
作者
夏雷
曹军涛
韩战记
XIA Lei;CAO Jun-tao;HAN Zhan-ji(Department of Anesthesiology,Luoyang Dongfang People's Hospital,Luoyang,Henan,471000,China)
出处
《中国血液流变学杂志》
2024年第4期561-566,共6页
Chinese Journal of Hemorheology
关键词
右美托咪定
利多卡因
剖宫产
血流动力学
凝血功能
应激反应
腰硬联合麻醉
Dexmedetomidine
Lidocaine
caesarean section
hemodynamics
coagulation function
stress response
combined epidural anesthesia
