| Objective:To explore the clinical effect of a project which is combined intraoperative dexmedetomidine with butorphanol as postoperative analgesia for parturients who are undergoing the secondary abdominal-wall vertical incision cesarean delivery(CD),which will provide anesthesiologists with a reasonable and effective theoretical basis for perioperative anesthesia and analgesia management,and make them explore the practical significance of ERAS concept for the application of obstetrics.Methods:Forty-six parturients(ASA I-II)were scheduled for secondary CD with a compared-spinal-epidural anesthesia way.The incision was a vertical abdominal incision(also called longitudinal incision).The criteria of these parturients are aged 25-45,155-170 cm in height and 60-85 kg in weight.Within 2 minutes after disconnecting the umbilical cord,DEX(0.5ug/kg)was used intravenously as loading dose in group A,and it was pumped out in fifteen minutes;Maintenance dose was then administered intravenously at 0.5ug/kg/h until the skin was sewn.Saline was administered in the same dose in group B in the same way of group A.Parturients in both groups used analgesic pump after operation,where the dose of butorphanol was 3.5ug/kg/h(background flow 2ml/h,additional flow 0.5ml/h,locking time 15min).Mean arterial pressure(MAP),heart rate(HR)were recorded at three points: before intravenous infusion(T1)?15 min after intravenous infusion(T2)and departure from the operating room(T3).At the end of the operation,the operative time,intraoperative blood loss and BIS value were recorded.VAS scores of postoperative incision resting pain and Ramsay sedation scores were also evaluated at another three points: departure from the operating room(T3),24 hours after surgery(T4),48 hours after surgery(T5).The maternal satisfaction with anesthesia and postoperative analgesia was investigated.Finally,Length of stay(LOS)was tallied.Results:1.Comparison of general information between the two groups There was no significant difference in general information such as age,height,weight and gestational age between the two groups(P>0.05).2.Comparison of hemodynamic changes in different phases between the two groupsIn group A,MAP and HR were decreased at the point of T2 compared with the point of T1,but the differences were not statistically significant(P>0.05).MAP and HR continued to decline at the point of T3,with statistically significant differences compared with T1(P<0.05).There was no significant difference in MAP between group A and group B(P>0.05).Compared with group B on HR,HR in group A was decreased at points of T2 and T3,with statistically significant difference(P<0.05),while another point showed no statistically significant difference(P>0.05).3.Comparison of the Monitoring indicators before leaving the operating room of the parturients in the two groupsThere were no significant differences about operation time and intraoperative blood loss between the two groups(P> 0.05).Compared with the group B,the BIS value of group A decreased,and the difference was statistically significant(P<0.05).4.Comparison of Ramsay and VAS scores at different poinrs between the two groupsCompared with group B,the Ramsay scores in group A at the points of T3 and T4 were higher than those in group B,with statistically significant differences(P<0.05).There was no significant difference in Ramsay scores between two groups at the point of T5,which was not statistically significant(P>0.05).The VAS score in group A was lower than that in group B at the point of T4,with statistically significant difference(P<0.05).The differences between the other two points were not significant,without statistical significance(P>0.05).In group A,the Ramsay scores at the points of T4 and T5 were lower compared with the point of T3,and the VAS scores were higher,both with statistically significant differences(P<0.05).The difference between the points of T4 with T5 was not obvious,with no statistical significances(P >0.05).5.Comparison of intraoperative adverse reactions between the two groupsCompared with group B,the incidence of nausea,shiver and abdominal discomfort in group A was less than those in group B,and the differences were statistically significant(P<0.05).Hypotension occurred more frequently in group A than group B,without significant difference(P>0.05).No adverse reactions such as vomiting ?bradycardia or respiratory depression occurred in both groups.6.Comparison on LOS and satisfaction rate between the two groupsLOS in group A was less than that in group B,without significant difference(P>0.05).Maternal satisfaction(satisfaction + great satisfaction / total cases each group)in group A was higher than that in group B,with statistically significant difference(P<0.05).Conclusion:A project,which was combined intraoperative dexmedetomidine(0.5ug/kg)with butorphanol(3.5ug/kg/h,PCIA)as bostoperative analgesia for parturients undergoing secondary CD with abdominal-wall vertical incision,reduced significantly the incidence of perioperative adverse reactions and stress response and make them sedative and analgesic,in which maternal satisfaction is high.It was in line with the concept of ERAS and provided reference for comfort medical treatment... |
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