Clinical Effects Of Dexmedetomidine Combined With Butorphanol In Preventing Traction Reaction During Second Cesarean Section

Objective:This paper discussed the prevention and treatment effects of the intravenous application of dexmedetomidine in combination with butorphanol,dexmedetomidine and butorphanol for the traction reaction in the second caesarean section of the maternal,and then sought a more optimized drug treatment scheme to prevent the traction reaction in the secondary caesarean section.Methods:According to the inclusion and exclusion criteria,90 patients who underwent the second cesarean section under combined spinal-epidural anesthesia（Combined Spinal-epidural Anesthesia,CSEA）in the operating room of the Department of Anesthesia of Jing Zhou Central Hospital from April 2020 to December 2020 were selected and randomly divided into dexmedetomidine in combination with butorphanol group（Group DB）,dexmedetomidine group（Group D）and butorphanol group（Group B）,the number of each group was 30 cases（n=30）.After the fetus was delivered and the umbilical cord was broken,group DB intravenous pumping 10ml of physiological saline dilution of the dexmedetomidine 0.8μg/kg plus butorphanol 1mg within 15 minutes,group D intravenous pumping 10ml of physiological saline dilution of the dexmedetomidine 0.8μg/kg within 15 minutes,group B intravenous pumping 10ml of physiological saline diluted butorphanol 1mg within 15 minutes.Recorded and compared the patient’s general basic data（age,height,weight,length of surgery,amount of bleeding and amount of infusion）,the basic vital signs of each operating node（when the fetus is delivered and the umbilical cord is broken-T₀,15 minutes after medication-T₁,when the uterine cavity is cleaned-T₂,when the abdominal cavity is cleaned-T₃,when the uterus is pressed at the end of the operation-T₄）,traction reaction rating,Ramsay sedative scale score（Ramsay Sedation Score,Ramsay）,nausea and vomiting,low blood pressure,high blood pressure,titration,chills;and the number of cases in which sufentanil was added during the operation.Results:1.General information on all mothers is not statistically significant（including age,height,weight,length of surgery,amount of bleeding,amount of infusion）（P>0.05）.2.Comparison of Basic vital signs in different operating nodes for all maternal,including average arterial pressure（Mean Arterial Pressure,MAP）,heart rate（Heart Rate,HR）,pulse oxygen saturation（Pulse Oxygen Saturation,Sp O₂）,respiratory rate（Breathing Rate,RR）:MAP comparison of three groups of patients,in T₂,Group DB,Group D compared to Group B,MAP decrease,there is a statistical gap between Group B and the other two groups（P<0.05）,in T₃,Group DB compared with Group B,MAP decrease,there is a statistical gap between groups（P<0.05）;HR comparison of three groups of patients,in T₁～T₄,Group DB,group D compared to Group B,HR slow down,Group B and the other two groups have a statistical gap（P<0.05）;Sp O₂ comparison of three groups of patients,in T₁～T₂,Group DB compared to Group D,Group B,Sp O₂ decreased,Group DB and the other two groups have statistical differences（P<0.05）,T₃,Group DB compared with Group B,Sp O₂ decreased,there is a statistical gap between groups（P<0.05）;RR comparison of three groups of patients,in T₁～T₃,Group DB compared to Group D,Group B,RR slow down,and there is a statistical difference between Group DB and the other two groups.3.Comparison of traction reactions at various operating node for three groups of patients:T₀、T₂,and T₄,three groups of patients with traction reactions were less statistically significant（P>0.05）;T₃,Group DB compared to group D,Group B,There is a statistical gap between the two groups（P<0.05）,Group D compared with Group B,There is a statistical gap between the two groups（P<0.05）,which means,the effect of preventing traction reactions during secondary cesarean section,Group DB is better than Group D,Group D is better than Group B.4.Ramsay scores comparison at various operating node for three groups of patients:T₀,Group DB,Group D compared to Group B,there is no difference in Ramsay scores among three groups of patients（P>0.05）,T₁to T₄,Group DB compared to Group D,Group B,There is a statistical gap between the two groups（P<0.05）,and Group D compared to Group B,There is a statistical gap between the two groups（P<0.05）,the calmness of the group DB was better than that of Group D and Group D was better than Group B.5.Comparison of adverse reactions and the number of supplementary sufentanil in three groups of patients:The comparison of nausea and vomiting,hypotension,hypertension,chills,and additional sufentanil among the groups were less statistically significant（P>0.05）;The number of bradycardia of Group B was significantly lower than that of Group DB,and There is a statistical gap between the two groups（P<0.05）;The comparison of bradycardia between Group DB and Group D is not statistically significant（P>0.05）;The comparison of bradycardia between Group D and Group B is not statistically significant（P>0.05）.Conclusions:1.After the fetus is delivered and the umbilical cord is broken,Intravenous pumping dexmedetomidine 0.8μg/kg+butorphanol 1mg,compared to a single intravenous pump with dexmedetomidine 0.8μg/kg or butorphanol 1mg,the effect of preventing Traction Reaction is better,and the sedative effect is best.2.Intravenous pumping dexmedetomidine 0.8μg/kg+butorphanol 1mg,the rate of bradycardia was higher than that of the intravenous pump injection butorphanol 1mg,therefore,the HR changes of patients need to be closely monitored and dealt with in a timely manner.