右美托咪定复合舒芬太尼对剖宫产术术后疼痛及炎性反应的影响

Effects of dexmedetomidine plus sufentanil on analgesic efficacy and inflammatory cytokine level in women following cesarean section

目的:探讨盐酸右美托咪定复合舒芬太尼在剖宫产术后自控镇痛中的效果以及对血清炎性细胞因子表达的影响。方法:选取2017年7月~2018年6月在宿州市立医院行剖宫产的孕妇100例,随机分为对照组和观察组各50例,对照组采用输注舒芬太尼进行自控镇痛(PCIA),观察组采用右美托咪定复合舒芬太尼进行自控镇痛(PCIA)。比较两组患者术后不同时间点的视觉模拟疼痛(VAS)评分、舒芬太尼用量、术后不良反应发生率、血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量。结果:术后12、24、48h,观察组产妇的VAS评分均低于对照组(P<0.05);术后12h,观察组产妇的舒芬太尼用量、自控镇痛泵的按压次数低于对照组(P<0.05);两组产妇的恶心呕吐、低氧血症、术后延迟恢复差异均无统计学意义(P>0.05),但观察组术后躁动低于对照组(P<0.05);两组产妇术后12h的血浆CRP、TNF-α、IL-10含量较组内术前均提高(P<0.05),且观察组产妇的CRP、TNF-α、IL-10提高幅度低于对照组(P<0.05)。结论:剖宫产术后右美托咪定复合舒芬太尼可减少炎症介质的释放,提高镇痛效果,促进产后恢复。

Objective:To investigate the clinical efficacy of dexmedetomidine hydrochloride combined with sufentanil in analgesic and the effect on the expression of plasma inflammatory cytokine level in women following cesarean section. Methods:One hundred women undergone cesarean section in Suzhou Municipal Hospital were included from July 2017 to June 2018,and equally randomized into control group and the observational group.Women in the control group were treated with sufentanil via patient-controlled intravenous analgesia (PICA),and those in observational group were managed with dexmedetomidine plus sufentanil for PICA.The two groups were compared concerning visual analogue scores(VAS),sufentanil dosage,postoperative adverse reactions,plasma c-reactive protein (CRP),tumor necrosis factor-alpha (TNF-α) and interleukin-10 (IL-10) at different time points following operation. Results:Women in the observational group had lower VAS scoring at 12 h,24 h and 48 h after surgery( P <0.05)as well as lower sufentanil dose and frequencies of PICA than those in the control group at postoperative 12 h ( P <0.05).The difference was insignificant in nausea,vomiting,hypoxemia and delayed postoperative recovery between groups( P >0.05).Women in the observational group had significantly lower postoperative restlessness than those in the control group ( P <0.05).Markedly elevated CRP,TNF-α and IL-10 levels at 12 h after surgery were seen in both groups,yet the increase of CRP,TNF-α and IL-10 was more obvious in the observational group( P <0.05). Conclusion:Combined dexmedetomidine with sufentanil can reduce the release of inflammatory mediators,and significantly improve the analgesic effect and promote postpartum recovery for women following cesarean section.