2020 年第 3 期 第 15 卷

右美托咪定对剖宫产患者卡前列素氨丁三醇不良反应与应激反应以及炎症反应的影响

Effect of dexmedetomidine on adverse reactions of carboprost tromethamine, stress and inflammatory response in patients undergoing cesarean section

作者：朱晨晓1刘江虹1李韶芳2胡志勋1宋瑞佳1

英文作者：

单位：1河北省邢台市第一医院麻醉科054001；2邢台医专第二附属医院麻醉科054001

英文单位：

关键词：剖宫产术；右美托咪定；卡前列素氨丁三醇；不良反应；应激炎症反应

英文关键词：

• 摘要：

• 【摘要】目的    探究右美托咪定对剖宫产患者的卡前列素氨丁三醇不良反应、应激反应以及炎症反应的影响。方法    选取2016年10月至2017年10月在河北省邢台市第一医院行剖宫产的孕妇80例。依照随机数字表法分为观察组和对照组，各40例。观察组在剖宫产术中静脉泵注盐酸右美托咪定注射液，对照组在剖宫产术中静脉泵注等容量0.9%氯化钠注射液。比较2组孕妇不同时间［手术前10 min（T1）、注入卡前列素氨丁三醇后10 min（T2）和手术结束后10 min（T3）］生命体征指标，T1和T3时应激反应指标、炎症因子指标、细胞免疫变化和不良反应发生情况。结果    观察组孕妇在T2和T3时平均动脉压和心率均低于对照组，脉搏血氧饱和度高于对照组，差异均有统计学意义（均P＜0.05）。2组孕妇T3时血清中应激反应指标皮质醇、去甲肾上腺素、醛固酮、血管紧张素Ⅱ水平均明显高于T1时，而T3时观察组低于对照组［（543±76）ng/L比（667±96）ng/L、（167±40）ng/L比（198±38）ng/L、（109±15）ng/L比（168±22）ng/L、（183±40）mmol/L比（279±46）mmol/L］，差异均有统计学意义（均P＜0.05）。2组孕妇血清中炎症因子变化与应激反应指标变化类似。2组孕妇T3时免疫细胞CD+3、CD+4和CD+4/CD+8比值较T1时明显下降，而T3时观察组高于对照组，差异均有统计学意义（均P＜0.05）。观察组孕妇恶心、呕吐、面色潮红、胸腹痛等不良反应发生率均低于对照组（均P<0.05）。结论    右美托咪定可降低术后应激炎症反应，有效减少卡前列素氨丁三醇注射所致不良反应发生，减轻孕妇手术不适感。

  
  

• 【Abstract】Objective    To investigate the effect of dexmedetomidine on adverse reactions, stress response and inflammatory response to carboprost tromethamine in cesarean section. Methods    Eighty pregnant women undergoing cesarean section in the First Hospital of Xingtai, Hebei Province between October 2016 and October 2017 were randomly divided into observation group and control group, with 40 cases in each group. The observation group had intravenous injection of dexmedetomidine hydrochloride during cesarean section and the control group used equal volume of 0.9% sodium chloride. Vital signs were recorded at different time points during operation［10 min before operation(T1), 10 min after carboprost tromethamine injection(T2), 10 min after operation(T3)］. Stress response, inflammation and cellular immune indicators were detected at T1 and T3. Adverse reactions were observed. Results    At T2 and T3, mean arterial pressure and heart rate in the observation group were significantly lower and pulse oxygen saturation was higher than those in the control group(all P<0.05). Serum levels of cortisol, noradrenaline, aldosterone and angiotension Ⅱ at T3 were significantly higher than those at T1; the levels at T3 in the observation group were lower than those in the control group［（543±76）ng/L vs （667±96）ng/L, （167±40）ng/L vs （198±38）ng/L, （109±15）ng/L vs （168±22）ng/L, （183±40）mmol/L vs （279±46）mmol/L］(all P<0.05). Changes in serum inflammatory factors were similar to stress response indicators. Levels of CD+3, CD+4 and CD+4/CD+8 at T3 were significantly reduced compared with those at T1; the indexes in the observation group were higher than those in the control group at T3(all P<0.05). Incidences of nausea, vomiting, flushed face, chest and abdominal pain in the observation group were significantly lower than those in the control group(all P<0.05). Conclusion    Dexmedetomidine can alleviate postoperative stress and inflammatory response and reduce adverse reactions caused by carboprost tromethamine injection in patients undergoing cesarean section.