右美托咪定和咪达唑仑预防剖宫产术后欣母沛所致恶心呕吐的比较：随机对照试验

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A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial

背景与目的

本研究旨在比较右美托咪定与咪达唑仑预防剖宫产术后欣母沛引起的恶心呕吐（PONV）的疗效。

方法

将ASA分级为I/II级，年龄20～40岁，硬膜外麻醉下行择期剖宫产的产妇105例，随机分为右美托咪定组（D组，n=35）、咪达唑仑组（M组，n=35）和对照组（C组，n=35）。胎儿娩出后立即宫内注射250 μg欣母沛，并持续静脉滴注缩宫素5个单位。同时D组静脉给予1μg/kg右美托咪啶，M组给予咪达唑仑0.02 mg/kg，C组给予生理盐水20mL。记录PONV、欣母沛引起的其他不良反应(胸闷、潮红等)、患者满意度、镇静评分(OAA/S)和血流动力学参数。

结果  

D组和M组PONV发生率明显低于C组（D组、M组和C组分别为6%、17%和71%，P<0.05）。D组和M组的镇静评分（OAA/S）明显高于C组（D组、M组和C组分别为1.62±0.28、1.75±0.31和1.00±0.00，P<0.05）。D组和M组患者满意度显著高于C组（D组、M组和C组分别为94%、69%和46%，P<0.05）。D组患者的满意度高于M组（94% vs 69%，P<0.05）。

结论

静脉注射右美托咪定（1μg/kg）和咪达唑仑（0.02 mg/kg）对预防欣母沛引起的PONV有同等效果，且右美托咪定组患者满意度优于咪达唑仑组。

原始文献来源及摘要

Hu B, Zhou H, Zou X, et al. A Comparison of Dexmedetomidine and Midazolam for the Prevention of Postoperative Nausea and Vomiting Caused by Hemabate in Cesarean Delivery: A Randomized Controlled Trial.[J].Drug Des Devel Ther, 2020, 14: 2127-2133.

Abstract

Objective: To compare the efficacy of dexmedetomidine and midazolam in the prevention of postoperative nausea and vomiting (PONV) caused by hemabate in postpartum hemorrhage during cesarean delivery.

Methods: One hundred and five parturients with American Society of Anesthesiology(ASA) physical status I and II, aged 20–40 years, undergoing elective cesarean delivery under epidural anesthesia were randomly allocated into dexmedetomidine group (group D, n=35), midazolam group (group M, n=35) and control group (group C, n=35). Patients received an intrauterine injection of 250 μg hemabate and continuous intravenous infusion of 5 units oxytocin immediately following the delivery of the infant. At the same time, patients in group D received 1μg/kg intravenous dexmedetomidine, group M received 0.02 mg/kg intravenous midazolam and group C received 20 mL intravenous saline. Parameters such as the PONV, other adverse reactions (chest distress, flush, etc.) caused by hemabate, patient satisfaction, the sedation (OAA/S) scores, and the hemodynamic parameters were recorded in both groups.

Results: The PONV incidence in group D and group M was significantly lower compared with group C (6%, 17%, and 71% for group D, group M, and group C, respectively, P<0.05).The sedation (OAA/S) scores in group D and group M was significantly higher compared with group C (1.62±0.28, 1.75±0.31, and 1.00±0.00 for group D, group M, and group C, respectively, P<0.05). The patient satisfaction in group D and group M was significantly higher compared with group C (94%, 69%, and 46% for group D, group M, and group C, respectively, P<0.05). Furthermore, there were more patients satisfied with group D than group M (94% vs.69%, P<0.05).

Conclusion: Intravenous dexmedetomidine (1 μg/kg) and midazolam (0.02 mg/kg) were equally effective in preventing PONV introduced by hemabate and dexmedetomidine is superior to midazolam in patient satisfaction.