硬膜外自控镇痛对剖宫产术后感染和血清内源性神经递质及泌乳素的影响

Effects of patient-controlled epidural analgesia on the infections and serum endogenous neurotransmitters and prolactin after cesarean section

目的分析硬膜外自控镇痛(Patient-controlled epidural analgesia,PCEA)对剖宫产术后感染及血清内源性神经递质、泌乳素水平的影响,为优化剖宫产术后镇痛管理提供研究依据。方法选取2017年10月-2018年10月于聊城市妇幼保健院行剖宫产手术的产妇1 496例为研究对象,随机分为研究组和对照组,每组748例。术后根据疼痛情况,给予对照组产妇肌肉注射盐酸哌替啶镇痛,给予研究组产妇盐酸罗哌卡因+枸橼酸芬太尼+氟哌利多PCEA。对两组产妇术后感染情况进行观察和对比。对两组产妇术后2 h和术后24 h时的视觉模拟评分法(VAS)评分进行评价和对比。对两组产妇术前和术后24 h时的血清P物质、β-内啡肽、神经肽Y、泌乳素水平进行检测和对比。结果研究组产妇术后感染率为4.28%(32/748)低于对照组7.35%(55/748)(P=0.011);在术后24 h时,两组产妇的VAS评分较术后2 h时下降,血清P物质、β-内啡肽、神经肽Y、泌乳素水平较术前上升(P<0.05),研究组产妇的VAS评分和血清P物质、β-内啡肽、神经肽Y分别为(1.53±0.12)分、(5.49±0.58)μg/ml、(35.06±3.63)ng/L、(188.86±18.41)μg/ml均低于对照组,血清泌乳素为(389.96±39.11)μg/L高于对照组(P均<0.05)。结论相对于应用传统的肌肉注射镇痛药物方案,在剖宫产术后采用PCEA的方式进行镇痛管理,能够达到较好的镇痛效果,降低产妇的术后感染率,缓解疼痛应激相关内源性神经递质的表达上调,提升术后血清泌乳素水平,有利于促进产妇的恢复、实现早期母乳喂养。

OBJECTIVE To analyze the effects of patient-controlled epidural analgesia(PCEA) on postoperative cesarean infection, serum endogenous neurotransmitters and prolactin levels, and to provide research basis for optimizing analgesia management after cesarean section. METHODS A total of 1 496 puerperants who underwent cesarean section in Liaocheng Maternal and Child Health Hospital from Oct. of 2017 to Oct. of 2018 were selected as the research subjects, and randomly divided into a study group and a control group, with 748 cases in each group. According to the pain situation, the puerperants in the control group were given with intramuscular injection of pethidine hydrochloride for postoperative analgesia, while the puerperants in the study group were treated with PCEA of ropivacaine hydrochloride plus fentanyl citrate plus droperidol. The infection conditionspostoperations of the puerperants in the two groups were observed and compared. The visual analogue scale(VAS) scores at 2 hour and at 24 hour after the operation of the puerperants were evaluated and compared between the two groups. The serum levels of substance P, β-endorphin, neuropeptide Y and prolactin levels were detected and compared before and at 24 hours after surgery between the two groups. RESULTS The postoperative infection rates of maternal patients in the study group were 4.28%(32/748), significantly lower than that in the control group(7.35%, 55/748)(P=0.011). At 24 hour after the operations, the VAS score of the two groups decreased significantly compared with 2 hour after the operations, and the serum levels of substance P, β-endorphin, neuropeptide Y and prolactin were increased compared with those before the operations(P<0.05). The VAS score and the serum levels of substance P, β-endorphin and neuropeptide Y of puerperants in the study group were(1.53±0.12),(5.49±0.58) μg/mL,(35.06±3.63) ng/L, and(188.86±18.41) μg/ml, respectively, significantly lower than those in the control group, and the serum prolactin level was(389.96±39.11)μg/L, significantly higher than that in control group(P<0.05). CONCLUSIONS Compared with the application of traditional intramuscular analgesic, the use of PCEA for analgesia management after cesarean section can achieve better analgesic effects, reduce the postoperative infection rate of puerperants, up-regulated the pain-alleviated stress-related endogenous neurotransmitters, increase the level of serum prolactin after the operation, which is beneficial to the recovery of pregnant women and early breastfeeding.