【摘要】 目的 观察右美托咪定联合蛛网膜下腔阻滞对剖宫产产妇应激反应及缩宫素引起的子宫收缩的影响。方法 前瞻性选取2021年2月至2023年4月在宜昌市妇幼保健院进行剖宫产的96例产妇作为研究对象，按照简单随机法分为观察组和对照组，每组各48例，均采用蛛网膜下腔阻滞。观察组术前10 min给予右美托咪定静脉泵注，直至手术结束，对照组术前10 min给予0.9%氯化钠溶液静脉泵注，直至手术结束。评估两组Ramsay镇静评分和使用缩宫素2、5、10 min后子宫收缩评分的差异，检测两组术前、术后1 h、术后24 h时应激反应指标[皮质醇、去甲肾上腺素(NE)、促肾上腺皮质激素(ACTH)、血管紧张素Ⅱ(AngⅡ)]水平，比较两组术后24、48 h的催乳素水平、初乳时间和安全性。结果 观察组麻醉10 min、胎儿娩出、手术结束时Ramsay镇静评分分别为(2.18±0.28)、(2.34±0.39)、(2.41±0.58)分，均高于对照组[(1.81±0.25)、(1.72±0.47)、(1.74±0.45)分],差异均有统计学意义(P<0.05)。两组使用缩宫素2、5、10 min后子宫收缩评分比较，差异均无统计学意义(P>0.05)。两组术后1 h时皮质醇、NE、ACTH、AngⅡ水平均较术前升高，两组术后24 h时NE、ACTH水平及对照组皮质醇、AngⅡ水平均较术前升高，但观察组术后1 h时皮质醇、NE、ACTH、AngⅡ水平分别为(287.85±51.07)ng/mL、(298.63±67.11)ng/L、(15.78±2.15)pg/mL、(197.45±36.21)ng/mL,均低于对照组[(314.45±56.21)ng/mL、(354.74±78.96)ng/L、(18.52±2.41)pg/mL、(227.41±42.03)ng/mL],观察组术后24 h时NE、ACTH、AngⅡ水平分别为(258.85±47.13)ng/L、(12.52±1.77)pg/mL、(172.25±34.12)ng/mL,均低于对照组[(312.25±69.14)ng/L、(14.63±1.85)pg/mL、(204.33±36.96)ng/mL],差异均有统计学意义(P<0.05)。两组术后24、48 h的催乳素及初乳时间比较，差异均无统计学意义(P>0.05)。两组不良反应发生率比较，差异无统计学意义(P>0.05)。结论 右美托咪定联合蛛网膜下腔阻滞可减轻剖宫产产妇应激反应，对缩宫素引起的子宫收缩程度、术后泌乳功能无显著影响，且不增加安全风险。更多还原

【Abstract】 Objective To observe the effects of dexmedetomidine combined with subarachnoid block on stress response and uterine contractions induced by oxytocin in women who delivered cesarean section. Methods Ninety-six cases of cesarean section admitted to Yichang Maternal and Child Health Hospital from February 2021 to April 2023 were prospectively selected as the study subjects, and they were divided into the observation group and the control group by simple randomisation method, 48 cases in each group, both of which used subarachnoid block. In the observation group, parturients were given dexmedetomidine intravenous pumping 10 min before surgery until the end of surgery, and in the control group, parturients were given 0.9% sodium chloride solution intravenous pumping 10 min before surgery until the end of surgery. Differences in Ramsay sedation score and uterine contraction score after 2 min, 5 min and 10 min of administration of oxytocin were assessed between the two groups, and the levels of stress response [cortisol, norepinephrine(NE), adrenocorticotropic hormone(ACTH), and angiotensin Ⅱ(Ang Ⅱ)] before operation, 1 h, 24 h after operation of the two groups were detected, and prolactin at 24 h, 48 h after operation, the duration of colostrum and safety were compared between the two groups. Results The Ramsay sedation scores at 10 min of anesthesia, fetal delivery and the end of operation in the observation group were(2.18±0.28),(2.34±0.39) and(2.41±0.58) points, respectively, which were higher than those in the control group [(1.81±0.25),(1.72±0.47) and(1.74±0.45) points], and the differences were statistically significant(P<0.05). There were no statistically significant differences in uterine contraction scores between the two groups after 2, 5 and 10 min of using oxytocin(P>0.05). The levels of cortisol, NE, ACTH and Ang Ⅱ at 1 h after operation in the two groups were higher than those before operation, the levels of NE and ACTH at 24 h after operation in the two groups and the levels of cortisol and Ang Ⅱ in the control group were higher than those before operation, but the levels of cortisol, NE, ACTH and Ang Ⅱ in the observation group at 1 h after operation were(287.85±51.07) ng/mL,(298.63±67.11) ng/L,(15.78±2.15) pg/mL and(197.45±36.21) ng/mL, respectively, which were lower than those in the control group [(314.45±56.21) ng/mL,(354.74±78.96) ng/L,(18.52±2.41) pg/mL,(227.41±42.03) ng/mL], the levels of NE, ACTH and Ang Ⅱ in the observation group at 24 h after operation were(258.85±47.13) ng/L,(12.52±1.77) pg/mL and(172.25±34.12) ng/mL, respectively, which were lower than those in the control group [(312.25±69.14) ng/L,(14.63±1.85) pg/mL,(204.33±36.96) ng/mL], the differences were statistically significant(P<0.05). There were no statistically significant differences in prolactin and colostrum time between the two groups at 24 and 48 h after operation(P>0.05). There was no statistically significant difference in the incidence of adverse reactions between the two groups(P>0.05). Conclusion Dexmedetomidine combined with subarachnoid block can alleviate the stress response of the parturient after cesarean section, and has no effect on the degree of uterine contraction caused by oxytocin and postoperative lactation function, and does not increase the safety risk.更多还原