The Effect Of Dexmedetomidine Combined With Sufentanil In The Spinal Canal On Shivering And Postoperative Recovery Of Cesarean Section Women

Objective:To study the effect of dexmedetomidine combined with sufentanil in the spinal canal on shivering and Postoperative Recovery of Cesarean Section Women.Methods:Sixty singleton full-term parturients,aged 18-35 years,150-175cm in height,45-95kg in weight,ASA I or II,were selected and divided into two groups（n=30）.Group S:A mixture of 5ug 0.1ml sufentanil+1%ropivacaine hydrochloride injection 1.0ml（10mg）+0.9ml cerebrospinal fluid（CSF）was extracted,2.0ml,and all were injected into subarachnoid space.SD group:A mixture of 5ug 0.1ml sufentanil+1%ropivacaine hydrochloride injection 1.0ml（10mg）+0.9ml cerebrospinal fluid（CSF）was extracted,2.0ml,and all were injected into subarachnoid space.After the fetus was delivered,intravenous administration of DEX 0.5μg.kg^-1.h^-1was carried out until the end of the operation.In both groups,2mg morphine was injected into the epidural cavity at the time of suture,and the epidural catheter was removed after surgery.Patients in the two groups underwent intravenous patient-controlled analgesia with the formula of 1.5ug/kg sufentanil+0.3mg/kg desoxocine+16mg ondasetron+0.9%normal saline to 100ml.The background dose of analgesia pump was 2ml/h,0.5ml was added in a single dose,and the locking time was 15min.The occurrence of shivering,traction pain,hemodynamic indexes at T₀（entering the operating room）,T₁（beginning of operation）,T₂（10min after subarachnoid injection）,T₃（end of operation）,postoperative recovery,Patient-controlled analgesia（PCA）pressing times,visual analogue pain scale（VAS）and sedation score（Ramsay Sedation score）at 1h,6h,12h and 24h after operation,adverse reactions and new symptoms were recorded The Apgar score at 1 min and 5 min after birth and the related indexes of umbilical artery blood were compared.Results:1.Hemodynamic comparison:when the heart rate of the two groups was at T₃,compared with that of the S group,the heart rate of the SD group showed a downward trend,the difference was statistically significant（P<0.05）.There was no significant difference in heart rate between the two groups at T₀,T₁and T₂（P>0.05）.There was no significant difference in diastolic and systolic blood pressure between the two groups at different time points（P>0.05）.2.Comparison of the occurrence of shivering and stretching pain:the incidence of shivering in the two groups was significantly lower than that in the S group,with statistical significance（P<0.05）;Compared with S group,the incidence of shivering in SD group was significantly decreased when the occurrence grade was 2,and the difference was statistically significant（P<0.05）.Compared with S group,the duration of shivering in SD group was decreased,and the difference was statistically significant（P<0.05）.There was no significant difference in the tractive pain between the two groups（P>0.05）.3.Postoperative analgesia was divided into VAS score at different time points after surgery,number of PCA pressing and consumption of sufentanil 24h after surgery.There was no significant difference in VAS at rest and exercise at 1h and 24h after obstetrics between the two groups（P>0.05）.The VAS of SD group at rest and exercise was lower than that of S group at 6h after operation,and the difference was statistically significant（P<0.05）.The VAS of SD group at resting was lower than that of S group at 12h postoperatively,and the difference was statistically significant（P<0.05）,while there was no statistically significant difference at exercise（P>0.05）.Compared with PCA pressing times,SD group was less than S group,and the difference was statistically significant（P<0.05）.24h postoperative sufentanil consumption（ug）in SD group was less than that in S group,and the difference was statistically significant（P<0.05）.4.Comparison of Ramsay sedation scores at different postoperatively time:The Ramsay sedation scores at 1h after gynecology were compared between the two groups.Compared with the S group,the scores in the SD group showed an upward trend,with statistical significance（P<0.05）;There was no significant difference in Ramsay sedation scores at 6h、12h and 24h after obstetrics between the two groups（P>0.05）.5.Postoperative recovery includes the first postoperative time out of bed and length of hospital stay.The first time of getting out of bed（h）after obstetrics was compared between the two groups.Compared with the S group,the score of SD group showed a downward trend,with statistical significance（P<0.05）.There was no significant difference in hospital stay（D）between the two groups（P>0.05）.6.Comparison of adverse reactions,dosage of vasoactive drugs,intraoperative urine volume and blood loss.The adverse reactions included nausea,vomiting,hypotension,sinus bradycardia and pruritus.Compared with the S group,the incidence of nausea in the SD group showed a downward trend,with statistical significance（P<0.05）.There was no significant difference in the incidence of vomiting,hypotension,sinus bradynia and pruritus between the two groups（P>0.05）.There was no significant difference in the amount of ephedrine and atropine between the two groups（P>0.05）.Compared with the S group,the score of SD group showed an increasing trend,and the difference was statistically significant（P<0.05）.There was no significant difference in intraoperative blood loss（ML）between the two groups（P>0.05）.7.Neonatal safety comparison included Apgar score comparison and umbilical artery blood related indexes comparison.There was no significant difference in Apgar score between the two groups（P>0.05）.There was no statistical significance in the comparison of related indexes of umbilical artery blood,including p H,PO₂,PCO₂and BE,between the two groups（P>0.05）.Conclusion:Dex combined with sufentanil in the spinal canal can reduce the incidence and duration of shivering in cesarean delivery women,enhance sedation and analgesia intensity,reduce the use of postoperative opioids,maintain hemodynamics stability,reduce perioperative adverse reactions,improve maternal satisfaction,speed up postoperative rehabilitation and have a good safety for newborns.