剖宫产中静脉注射右美托咪定及其在乳汁中的浓度
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Intravenous dexmedetomidine for cesarean delivery and its concentration in colostrums
背景与目的
右美托咪定是具有高α2肾上腺素能受体选择性的镇静剂。本研究主要观察静脉注射右美托咪定在椎管内麻醉下进行剖宫产术中的作用及其在初乳中的浓度。.
方 法
本研究纳入了27名于硬联合麻醉下行剖宫产的产妇。分娩及断脐后，静脉持续注射右美托咪定（6μg/ kg / h ）10分钟，然后剂量调整为
0.7μg/ kg / h，直到关腹完毕。于注射右美托咪定后6h、12h、24h记录产妇镇静评分、生命体征及副作用，并收集产妇的血液及初乳样品，使用液相质谱分析仪分析样品。
结 果
初乳样品来自10名产妇，产后0h产妇血浆右美托咪定平均浓度为
333（303～534）pg／ml,产后6h为12.3（8.1～20.1）pg／ml，24h内右美托咪定代谢完全。6h乳汁-血浆比为0.76（0.57～0.86），婴儿的相对剂量为0.034%（0.020～0.062%）。右美托咪定停止使用时，镇静评分为-2分（-4～-1分）。术中产妇未出现恶心、腹膜刺激征及分娩后疼痛等情况。
结 论
所有产妇右美托咪定乳汁-血浆比均小于1，婴儿相对剂量非常低，所以剖宫产中使用右美托咪定镇静对婴儿不太可能造成危害。
原始文献摘要
Yoshimura , Kunisawa , Suno , et al； Intravenous dexmedetomidine for cesarean delivery and its concentration in colostrum.[J]； International Journal of Obstetric Anesthesia, 2017.
Background: Dexmedetomidine is a sedative agent with high a2-adrenoreceptor selectivity. We investigated intravenous dexmedetomidine administration during scheduled cesarean delivery under neuraxial anesthesia; and its concentration in the colostrum.
Methods: Twenty-seven participants having elective cesarean delivery under combined spinal-epidural anesthesia were enrolled. After delivery and cord clamping, 6 ug/kg/h of intravenous dexmedetomidine was administered for 10 minutes, followed by a dose of 0.7 ug/kg/h until peritoneal closure. Sedation, vital signs and side effects were recorded. Blood and colostrum samples were collected from each participant at 6, 12, and 24 h after dexmedetomidine administration. Samples were analysed using liquid chromatography tandem-mass spectroscopy.
Results: Colostrum samples were collected from 10 patients. The median [95% CI] plasma dexmedetomidine concentration was 333 [303–534] pg/ml at 0 h and 19.7 [13.5–25.8] pg/ml at 6 h. The colostrum concentration was 12.3 [8.1–20.1] pg/ml at 6 h. The dexmedetomidine completely disappeared from both within 24 h. The calculated milk-to-plasma ratio at 6 h was 0.76 [0.57–0.86]. The relative infant dose was 0.034% [0.020–0.062%]. At dexmedetomidine discontinuation, the Richmond Agitation–Sedation Scale score was _2 (range,_4 to _1). During surgery, no patients complained of nausea, peritoneal irritation or afterbirth pain.
Conclusions: The dexmedetomidine milk-to-plasma ratio did not exceed 1 in any participant, and the relative infant dose was very low. Maternal sedation using dexmedetomidine is unlikely to be harmful for the infant.
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