盐酸氢吗啡酮联合静脉泵镇痛对剖宫产产妇的镇痛效果及恢复情况的影响

Effects of hydromorphone hydrochloride combined with intravenous pump analgesia on the analgesic effects and recovery of puerperae after cesarean section

目的观察盐酸氢吗啡酮在剖宫产术后硬膜外镇痛中的应用效果。方法选取2017年3月至2018年3月中国人民解放军第九八医院诊治的120例剖宫产产妇作为研究对象。随机分为A组、B组,各60例。A组产妇于手术结束后经硬膜外导管缓慢注入盐酸氢吗啡酮联合静脉泵镇痛,B组产妇仅给予静脉泵镇痛,比较两组的镇痛、镇静效果,术后血清疼痛介质含量变化、不良反应发生情况及产妇术后恢复情况。结果 A组产妇术后6h、术后12h、术后24h VAS评分均低于B组,差异具有统计学意义(P<0.05)。两组产妇术后6h、术后12h、术后24h Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。两组产妇术后5d血清SP、5-HT、NE、NO含量低于同组术后1d,术后5d血清β-EP含量于同组术后1d,差异均具有统计学意义(P<0.05)。A组产妇术后5d血清SP、5-HT、NE、NO含量低于B组术后5d,术后5d血清β-EP含量显著高于B组术后5d,差异具有统计学意义(P<0.05)。两组产妇术后不良反应总发生率差异无统计学意义(P>0.05)。A组产妇初乳时间、肠排气时间、下床活动时间、自主排尿时间均早于B组,差异具有统计学意义(P<0.05)。结论盐酸氢吗啡酮联合静脉泵镇痛可显著减轻剖宫产术后疼痛,减少疼痛介质释放,促进抑疼痛介质释放,改善产妇术后恢复。

Objective To observe the application effects of hydromorphone hydrochloride in epidural analgesia after cesarean section. Methods 120 puerperae with cesarean section in the 98 th Hospital of the People′s Liberation Army of China from March 2017 to March 2018 were selected and randomly divided into group A and group B, each with 60 cases. Group A was slowly injected with hydromorphone hydrochloride via epidural catheter and intravenous pump analgesia after the end of surgery, and group B was only given intravenous pump analgesia. The analgesic effects and sedative effects, changes in serum medium pain content, occurrence of adverse reactions and postoperative recovery of puerperae were compared between the two groups. Results The VAS scores of group A were significantly lower than those of group B at 6 h, 12 h and 24 h after surgery(P<0.05). There were no significant differences in Ramsay sedation scores between the two groups at 6 h, 12 h and 24 h after surgery(P>0.05). The levels of serum SP, 5-HT, NE and NO in the two groups at 5 d after surgery were significantly lower than those in the same group at 1 d after surgery, and the serum β-EP content at 5 d after surgery was significantly higher than that in the same group at 1 d after surgery, all with statistically significant differences(P<0.05). The levels of serum SP, 5-HT, NE and NO in group A at 5 d after surgery were significantly lower than those in group B at 5 d after surgery, and the serum β-EP level at 5 d after surgery was significantly higher than that in group B at 5 d after surgery, all with statistically significant differences(P<0.05). There was no significant difference in the total incidence rate of postoperative adverse reactions between the two groups(P>0.05). The colostrum time, intestinal exhaust time, ambulation time, and spontaneous urination time in group A were significantly earlier than those in group B, with statistically significant differences(P<0.05). Conclusions Hydromorphone hydrochloride combined with intravenous pump analgesia can significantly reduce postoperative pain of cesarean section, reduce the release of medium pain, increase the release of pain suppressor, and improve postoperative recovery of puerperae.