3种麻醉药物椎管内超前镇痛对剖宫产术后镇痛效果的影响

Effect of intraspinal preemptive analgesia of hydromorphone hydrochloride on the analgesia after cesarean section

目的比较3种麻醉药物椎管内超前镇痛对剖宫产术后镇痛效果的影响。方法选取2015年5月至2016年5月在张家口市第五医院接受剖宫产且术后接受镇痛的480例产妇为研究对象，依据镇痛方法分为盐酸氢吗啡酮组280例、吗啡组100例及布比卡因组100例。3组产妇均做术前常规准备，L2-3间隙腰一硬联合麻醉，分别于手术结束15min前以盐酸氢吗啡酮0．20mg、吗啡2．00mg、布比卡因18．75mg，加入9g·L-1氯化钠8mL硬膜外导管单次注入，术毕拔除硬膜外导管，常规行术后静脉镇痛；于入室时及气管导管拔除后5min抽取肘静脉血测定血浆多巴胺（DA）、肾上腺素（E）、去甲肾上腺素（NE）水平，术后6、12、24、48h采用视觉模拟评分（VAS）记录镇痛效果，Ram-say镇静评分记录镇静效果。结果盐酸氢吗啡酮组产妇术后6、12、24、48hVAS评分优于吗啡组和布比卡因组（P〈0．05），且吗啡组低于布比卡因组（P〈0．05）；3组产妇术后6、12、24、48hRamsay评分比较差异无统计学意义（P〉0．05）。气管导管拔除后5rain3组产妇DA、E、NE水平较麻醉前均升高（P〈0．05），且盐酸氢吗啡酮组显著低于吗啡组和布比卡因组（P〈0．05）。结论椎管内盐酸氢吗啡酮单次给药超前镇痛效果较吗啡和布比卡因好，且不影响术后苏醒质量，并能降低应激反应。

Objective To explore the effect of intraspinal preemptive analgesia of hydromorphone hydrochloride on the analgesia after cesarean section. Methods A total of 480 puerpera who admitted in the Fifth Hospital of Zhangjiakou City from May 2015 to May 2016 for cesarean section and accepted analgesia were included in this study and were divided into the hydromorphone hydrochloride group （ n = 280 ）, morphine group（ n = 100 ）, and bupivacaine group （ n = 100 ） according to the different analgesia methods. The puerpera in the three groups were performed with routine preoperative preparations and all pa- tients were given L2.3 combined spinal epidural anesthesia. The single epidural injection of hydromorphone hydrochloride （0.20 mg）, morphine （ 2.00 mg）, and bupivacaine （ 18.75 mg） ＋ 9 g ~ L- 1 NaC1 （ 8 mL） was performed respectively at 15 min before the end of operation. The epidural catheter was removed after operation and the routine postoperative intravenous analgesia was performed. The elbow venous blood when entering the operation room and 5 min after removing the tracheal cath- eter was extracted to detect the plasma dopamine（ DA ）, epinephrine （E）, and noradrenaline （NE） levels. The visual analogue scales （VAS） was used to record the analgesia effect at 6,12,24, and 48 h after operation and the Ramsay was used to record the sedation effect. Results The VAS scores of patients at 6,12,24, and 48 h after operation in the hydromorphone hydrochlo- ride group were significantly superior to those in the morphine group and bupivacaine group （P 〈 0.05 ） ;moreover, the VAS scores of patients in morphine group were significantly lower than those in the bupivacaine group （P 〈 0.05 ）. There were no statistic difference of the Ramsay scores at 6,12,24,and 48 h after operation among the three groups（P 〉0.05）. The DA,E, and NE levels of patients at 5 min after removing the tracheal catheter in the three groups were significantly elevated compared with before anesthesia （ P 〈 0.05 ） ; and above indexes in the hydromorphone hydrochloride group were significantly lower than those in the morphine group and bupivacaine group （ P 〈 0.05 ）. Conclusion Intraspinal preemptive analgesia of hydromor-phone hydrochloride has a definite analgesia effect,and it doesn＇t affect the postoperative recovery quality, and can reduce the stress reaction.