广州医科大学学报

目的：探讨右美托咪定联合腰硬麻醉在子痫前期产妇剖宫产中的应用效果。方法：收集2019年12月至2022年12月本院收治的行剖宫产术的子痫前期产妇78例，随机分为观察组与对照组，每组39例。两组产妇均实施腰硬联合麻醉，观察组于胎儿娩出后输注右美托咪定，对照组给予等量的生理盐水。比较两组麻醉质量、各时点镇静Ramsay评分、血液动力学指标及应激反应指标。结果：两组神经阻滞起效时间、运动阻滞起效时间及达到最高麻醉平面时间比较，差异均无统计学意义（均P>0.05）。麻醉后10 min、20 min及术后24 h，观察组镇静Ramsay评分均显著高于对照组（均P<0.05）。各时点两组平均动脉压（MAP）组间比较，差异均无统计学意义（均P>0.05）。麻醉前两组产妇心率（HR）组间比较，差异无统计学意义（P>0.05）；胎儿娩出后10 min、术后24h观察组HR均低于对照组（均P<0.05）。术后1 h两组血清皮质醇（Cor）、超氧化物歧化酶（SOD）及丙二醛（MDA）水平均高于麻醉前（均P<0.05）。术后1 h观察组血清Cor及MDA水平均低于对照组，而SOD水平高于对照组（均P<0.05）。结论：实施剖宫产的子痫前期产妇行右美托咪定联合腰硬麻醉，可提高麻醉及镇静效果，维持血流动力学稳定，减少应激反应，有助于产妇顺利度过围产期。

Objective:To investigate the effect of dexmedetomidine combined with spinal epidural anesthesia in cesarean section of preeclampsia parturients.Methods:A total of 78 pregnant women with preeclampsia who underwent cesarean section in our hospital from December 2019 to December 2022 were collected and randomly divided into observation group and control group,with 39 cases in each group. Both groups were given combined spinalepidural anesthesia. The observation group was infused with dexmedetomidine after delivery of the fetus,and the control group was given the same amount of normal saline. The anesthesia quality,and sedation Ramsay score,hemodynamic indexes,stress response indexes at different time point were compared between the two groups.Results:There was no significant difference in the onset time of nerve block,the onset time of motor block and the time to reach the highest anesthesia plane between the two groups(all P>0.05). At 10 min,20 min after anesthesia and 24 h after operation,the Ramsay scores of sedation in the observation group were significantly higher than those in the control group(all P<0.05). There was no significant difference in mean arterial pressure(MAP)between the two groups at each time point(all P>0.05). There was no significant difference in heart rate(HR)between the two groups before anesthesia(P>0.05). The HR of the observation group were lower than those of the control group at 10 min after delivery and 24 h after operation(both P<0.05). The levels of serum cortisol(Cor),superoxide dismutase(SOD)and malondialdehyde(MDA)in the two groups at 1 h after operation were higher than those before anesthesia(all P<0.05). At 1 h after operation,the levels of serum Cor and MDA in the observation group were lower than those in the control group,while the level of SOD was higher than that in the control group(all P<0.05).Conclusion:Dexmedetomidine combined with spinal-epidural anesthesia for preeclampsia parturients undergoing cesarean section can improve the effect of anesthesia and sedation,maintain hemodynamic stability,reduce stress response,and help parturients pass the perinatal period smoothly.