氢吗啡酮复合罗哌卡因用于剖宫产术后硬膜外自控镇痛效果及对血流动力学、氧化应激、内质网应激的影响

The effects of hydromorphone combined with ropivacaine on patient-controlled epidural analgesia after cesarean section and its influence on hemodynamics,oxidative stress and endoplasmic reticulum stress

目的观察氢吗啡酮复合罗哌卡因应用于剖宫产术后硬膜外自控镇痛(PCA)效果及对血流动力学、氧化应激、内质网应激的影响。方法选取2017年5月至2018年5月行剖宫产的产妇100例,随机分为罗哌卡因组和联合组,每组50例。2组均行腰硬联合麻醉,手术结束后接自控镇痛泵。罗哌卡因组配方:0.75%罗哌卡因20 ml+欧贝4 mg+0.9%氯化钠溶液稀释至100 ml。联合组配方:0.75%罗哌卡因20 ml+氢吗啡酮0.3 mg+欧贝4 mg+0.9%氯化钠溶液稀释至100 ml。术后进行随访,比较2组术后4 h、8 h、16 h、24 h VAS评分、麻醉效果(镇痛时间、麻醉起效时间)、PCA按压次数、镇痛药物用量、不良反应及术后1 h、12 h、24 h血流动力学指标[心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)]、胎盘组织氧化应激指标(ROS、RNS、GPx、CAT)、内质网应激指标(GRP78、ERdj1、CHOP、ASK1)变化。结果联合组术后4 h、8 h、16 h、24 h VAS评分明显低于罗哌卡因组,差异有统计学意义(P<0.05)。联合组镇痛时间明显长于罗哌卡因组,麻醉起效时间明显短于罗哌卡因组,PCA按压次数、镇痛药物用量明显少于罗哌卡因组,不良反应发生率明显低于罗哌卡因组,差异有统计学意义(P<0.05)。联合组术后12 h、24 h MAP、SpO2明显高于罗哌卡因组,差异有统计学意义(P<0.05)。联合组胎盘组织ROS、RNS、GRP78、ERdj1、CHOP、ASK1明显低于罗哌卡因组,GPx、CAT明显高于罗哌卡因组,差异有统计学意义(P<0.05)。结论硬膜外注入氢吗啡酮和罗哌卡因用于剖宫产术后自控镇痛效果确切,且安全性高,能够维持血流动力学稳定,并抑制胎盘组织氧化应激和内质网应激。

Objective To observe the effects of hydromorphone combined with ropivacaine on patient-controlled epidural analgesia(PCA)after cesarean section and its influence on hemodynamics,oxidative stress and endoplasmic reticulum stress.Methods A total of 100 parturients, who underwent cesarean section in our hospital from May 2017 to May 2018, were randomly divided into ropivacaine anesthesia group(n=50) and combination anesthesia group(n=50). The combination spinal-epidural anesthesia was performed in all the parturients and patient-controlled analgesia pump was offered after surgery. The patients in ropivacaine anesthesia group were treated by 0.75% ropivacaine 20 ml+ondansetron hydrochloride 4 mg+0.9% sodium chloride solution 100 ml,however,the patients in combination anesthesia group were treated by 75% ropivacaine 20 ml+hydromorphone 0.3 mg+ondansetron hydrochloride 4 mg+0.9% sodium chloride solution 100 ml,and all the patients were followed up after operation. And the VAS scores at 4 h,8 h,16 h and 24 h after operation,and the anesthetic effects(analgesia time, onset time of anesthesia), PCA pressure times, dosage of analgesic, adverse reactions, hemodynamic parameters(GR, MAP and SpO2), placenta oxidative stress parameters(ROS, RNS, GPx and CAT) and endoplasmic reticulum stress indexes(GRP78,ERdj1,CHOP, ASK1) of the patients were observed and compared between the two groups.Results The VAS scores at 4 h,8 h,16 h and 24 h after operation in combination anesthesia group were significantly lower than those in ropivacaine anesthesia group(P<0.05). Moreover, the analgesia time and onset time of anesthesia in combination anesthesia group was significantly longer and shorter than that in ropivacaine anesthesia group,respectively. Moreover the PCA pressing frepuency, and the dosage of analgesics in combination anesthesia group were significantly less than those in ropivacaine anesthesia group,and the incidence rates of adverse reactions in combination anesthesia group were significantly lower than those in ropivacaine anesthesia group(P<0.05). Furthermore, the MAP and SpO2 at 12 h and 24 hcombination anesthesia group were significantly lower than those in ropivacaine anesthesia group,but the levels of GPx and CAT in combination anesthesia group were significantly higher than those in ropivacaine anesthesia group( P < 0. 05).Conclusion When used in PCA after cesarean section,hydromorphone combined with ropivacaine can maintain the stability of hemodynamics,inhibit oxidative stress and endoplasmic reticulum stress,with a higher safety and analgesia effect.