摘要
目的观察咪达唑仑复合芬太尼在剖宫产术中抑制内脏牵拉反应的临床效果及可行性。方法 90例单胎、无妊高征及胎儿宫内窘迫等并发症的产妇,随机分为两组:观察组和对照组,每组45例,两组均行硬腰联合阻滞麻醉。观察组婴儿娩出2 min后静脉注射咪达唑仑0.05 mg/kg,7 min后静脉注射芬太尼1μg/kg。对照组在与观察组相同的时点给予等体积的生理盐水。术中记录麻醉开始时(T0)、脊麻完成侧卧时(T1)、仰卧时(T2)、娩出婴儿后(T3)、咪达唑仑给药后3 min(T4)、芬太尼给药后2 min(T5)、牵拉子宫时(T6)、缝合腹膜时(T7)及术毕时(T8)的心率(HR)、收缩压(SBP)、舒张压(DBP)、呼吸频率(RR)、血氧饱和度(Sp O2),并记录术中出现宫缩痛及牵拉反应的例数、预输液量、总输液量、手术时间。结果观察组牵拉反应的发生较对照组要少(P<0.05),两组宫缩痛比较差异无统计学意义。对照组T7时HR、SBP和DBP较T0-T6显著增加(P<0.05);观察组在给予咪达唑仑与芬太尼干预后(T4,T5,T6,T7时点)仅呼吸频率和血氧饱和度较T0-T3时下降(P<0.05),但血氧饱和度处于正常范围;评价循环的指标(HR、SBP、DBP)在牵拉腹膜时观察组比对照组明显减小(P<0.05)。结论咪达唑仑复合芬太尼序贯静脉注射可有效抑制剖宫产术中的内脏牵拉反应,且安全可行。
Objective To explore the inhibitive effects of combined administration of midazolam with fentanyl on the visceral traction re- sponses in parturients with emergency cesarean section. Methods Totally 90 parturients of single birth,no gestational hypertension,no fetal distress and no other complications were randomized into two groups： observation group and control group （n =45 in each group）. All parturients were given spinal-epidural anesthesia. The parturients in observation group were intravenously injected with 0.05 mg/kg midazolam at 2 min after the delivery of baby, and 1 μg/kg fentanyl at 7 min after the delivery of baby. The parturients in control group were administered intravenously with equal volume of saline at the same time points. HR,SBP,DBP,RR,SpO2 were recorded at the start of anesthesia（ T0 ） ,at the completion of spinal anesthesia（ T1 ） ,at the time in supine position（ T2 ） ,after the delivery of fetus（ T3 ） ,3 min after administration of midazolam（ T4 ） ,2 rain after administration of fentanyl （T5 ）, the time of pulling the uterus （T6 ）, the time of closing the peritoneum（ T7 ） and at the end of surgery （Ts ）. The incidence of uterine pain and stretch reaction, pretransfusion volume, total amount of infusion, operation time were also recorded. Results The frequency of traction response was less in observation group than in control group（ P 〈 0.05 ）, but there was no statistical difference in the number of uterine pain between two groups. Compared with TO - T6, HR, SBP and DBP in control group were increased significantly at T7 （P 〈 0.05 ）. Compared with T0 -T3, the respiratory rate and oxygen saturation were decreased in observation group at T4 ,T5 ,T6 ,T7 （P 〈 0.05 ） ,but the oxygen saturation was in the normal range. HR ,SBP, DBP were lower in observation group than in control group at T7 （P 〈 0.05 ）. Conclusion Midazolam and fentanyl sequential administration in cesarean section could effectively inhibit the visceral traction
出处
《山西医科大学学报》
CAS
2015年第1期92-95,共4页
Journal of Shanxi Medical University
关键词
咪达唑仑
芬太尼
剖宫产
牵拉反应
midazolam
fentanyl
cesarean section
visceral traction reaction
