不同水平氯普鲁卡因联合吗啡对剖宫产产妇术后炎症因子及疼痛程度的影响

Effects of different concentrations of chloroprocaine combined with morphine on postoperative inflammatory factors and pain degree in parturient women with cesarean section

目的探讨不同水平氯普鲁卡因联合吗啡对剖宫产产妇术后炎症因子及疼痛程度的影响。方法选取该院2017年1-12月收治的192例行剖宫产的产妇作为研究对象,随机分成A、B、C 3组,每组64例。3组均采取腰硬联合镇痛方式,注射吗啡2 mg,10 min后3组分别注射2.0%、2.5%和3.0%的氯普鲁卡因5 mL。比较3组产妇术前和术后不同时间段(术后2、6、12、24、48 h)的炎症因子[血清白细胞介素(IL)-2、IL-6、IL-10及肿瘤坏死因子-α(TNF-α)]水平;比较3组产妇术前和术后不同时间段(术后2、6、12、24、48 h)视觉模拟评分量表(VAS)评分、Ramsay镇静评分;比较3组产妇术后药物不良反应的发生率。结果术前3组产妇的炎症因子(IL-2、IL-6、IL-10及TNF-α)水平相近,差异均无统计学意义(P>0.05);术后12 h和24 h 3组产妇的IL-2、IL-6、IL-10及TNF-α水平比较,A组>C组>B组,差异均有统计学的意义(P<0.05)。术后2、6 h,A组IL-2、IL-6、IL-10、TNF-α水平高于C组(P<0.05)。术前,3组的VAS评分、Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。术后48 h内VAS评分,B、C组组间差异无统计学意义(P>0.05),A、B组组间两两比较,A、C组组间两两比较,以及各组内术后各时间点与术前两两比较,差异均有统计学意义(P<0.05)。3组产妇术后48 h内Ramsay镇静评分组间两两比较、各组内术后48 h内各时间点与术前比较,差异均有统计学意义(P<0.05)。3组产妇的不良反应的发生率分别为17.18%、18.75%和23.44%,差异均无统计学意义(P>0.05)。结论2.5%氯普鲁卡因联合吗啡用于剖宫产术中镇痛、镇静效果较好,可降低术后48 h炎症因子水平,利于产妇恢复。

Objective To investigate the effects of different concentrations of chloroprocaine combined with morphine on postoperative inflammatory factors and pain degree in parturient women with cesarean section.Methods One hundred and ninety-two parturient women undergoing cesarean section in this hospital from January 2017 to December 2017 were selected as the study subjects and randomly divided into the group A,B and C,64 cases in each group.The three groups adopted the spinal-epidural combined analgesic mode and were injected by 2 mg morphine,then at 10 min after injection 5 mL of 2.0%,2.5%,3.0%chloroprocaine was injected in the group A,B and C.The levels of inflammatory factors(IL-2,IL-6,IL-10 and TNF-α)before operation and at postoperative 2,6,12,24,48 h were recorded and compared among the three groups,the pain visual analogue scale(VAS),Ramsay sedation scores at different time periods before and after operation were recorded and compared among the three groups,and the incidence rates of postoperative adverse drug reactions were recorded and compared among the three groups.Results The levels of inflammatory factors(IL-2,IL-6,IL-10 and TNF-α)before operation were similar in the three groups,and the difference was not statistically significant(P>0.05).The levels of IL-2,IL-6,IL-10 and TNF-αat postoperative 12,24 h had statistically significant difference among the three groups,the group A>group C>group B(P<0.05).The levels of IL-2,IL-6,IL-10 and TNF-alpha at postoperative 2,6 h in the group A were higher than those in the group C(P<0.05).The VAS score and Ramsay sedation score before operation had no statistically significant difference among the three groups(P>0.05).The VAS score within postoperative 48 h had no statistical difference between the group B and C(P>0.05);which between the group A and B,between the group A and C and intra-group comparison of 3 groups at postoperative various time points had statistically significant difference(P<0.05).The pairwise comparison in Ramsay sedation score within postoperative 48 h among 3 groups,comparison between before operation and at various time points within postoperative 48 h had statistically significant difference(P<0.05).The occurrence rates of adverse reactions in the three groups were 17.18%,18.75%and 23.44%respectively,which had no statistically significant difference(P>0.05).Conclusion 2.5%chloroprocaine combined with morphine used in cesarean section has a better analgesic and sedative effect,can decrease the level of inflammatory factors at postoperative 48 h,and is conducive to maternal recovery.