切口局部浸润麻醉联合镇痛泵术后镇痛在剖宫产产妇中的应用

Local Incision Infiltration Injection Combined with Analgesia Pump Postoperative Analgesia in Pregnant Women after Cesarean Section

目的:探讨切口局部浸润注射0.5%罗哌卡因联合镇痛泵术后镇痛在剖宫产产妇中的应用效果。方法:回顾性分析200例剖宫产产妇,将采用生理盐水切口浸润联合镇痛泵的100例为对照组,采用切口局部浸润注射0.5%罗哌卡因联合镇痛泵的100例为观察组。比较2组术后恢复情况(下肢肌力恢复时间、术后排气时间、术后排尿时间、首次下床时间)、术后不同时间点泌乳素(PRL)、疼痛(VAS)评分、手术前后疼痛应激相关指标[β-内啡肽(β-EP)、P物质(SP)]变化、不良反应。结果:2组比较,观察组下肢肌力恢复时间[(5.22±1.10)vs(7.24±1.58) h]、术后排气时间[(14.32±3.41)vs(17.85±3.86) h]、术后排尿时间[(23.12±4.74)vs(25.68±4.87) h]、首次下床时间[(20.10±3.89)vs(23.42±5.10) h]短于对照组(P<0.05);术后12 h血清PRL水平[(214.23±15.50)vs(208.87±16.10)μg·L-1]、术后24 h[(304.25±20.12)vs(268.58±18.96)μg·L-1]、术后48 h[(401.25±22.12)vs(368.58±20.10)μg·L-1]高于对照组(P<0.05);术后12 h VAS评分[(2.85±1.10)vs(4.52±1.54)分]、术后24 h[(2.00±0.85)vs(3.41±1.12)分]、术后48 h[(1.35±0.65)vs(1.84±0.95)分]低于对照组(P<0.05);术后12 h血清β-EP水平[(31.24±3.74)vs(28.14±2.85) ng·L-1]、术后24 h[(35.10±4.02)vs(30.12±3.11) ng·L-1]、术后48 h[(39.10±4.58)vs(35.58±3.85) ng·L-1]高于对照组(P<0.05);术后12 h血清SP水平[(7.32±2.24)vs(9.87±2.54)μg·mL-1]、术后24 h[(5.11±1.25)vs(7.10±1.84)μg·mL-1]、术后48 h[(3.54±1.01)vs(5.32±1.32)μg·mL-1]低于对照组(P<0.05);观察组不良反应发生率(13.00%)与对照组(11.00%)比较,差异无统计学意义(P>0.05)。结论:切口局部浸润注射0.5%罗哌卡因联合镇痛泵术后镇痛可加速产妇术后恢复,促进早期泌乳,降低术后疼痛感,减轻疼痛应激反应,且不良反应少,是剖宫产术后有效镇痛方式。

Objective: To investigate the effect of local incision infiltration injection of 0.5% ropivacaine combined with analgesia pump on postoperative analgesia in women undergoing cesarean section. Methods: A retrospective analysis was performed on 200 cases of caesarean section pregnant women admitted. 100 cases of continuous incision infiltration with normal saline combined with analgesia pump were taken as the control group, and 100 cases of local incision infiltration injected with 0.5% ropivacaine combined with analgesia pump were taken as the observation group. Postoperative recovery(lower limb muscle strength recovery time, postoperative exhaust time, postoperative urination time, first time out of bed), prolactin(PRL), pain(VAS) score, pain stress [-endorphin(-EP), substance P(SP)] changes and adverse reactions before and after operation were compared between the two groups. Results: The recovery time of lower limb muscle strength in the observation group, postoperative exhaust time, postoperative urination time, first time out of bed were shorter than those in the control group(P<0.05). VAS scores 12 h after surgery, 24 h after surgery, 48 h after surgery in the observation group were lower than those in the control group(P<0.05). The serum PRL levels in the observation group were higher than those in the control group(P<0.05), 12 h after surgery, 24 h after surgery, 48 h after surgery. The serum-EP levels in the observation group were higher than those in the control group(P<0.05). The serum SP level of the observation group was lower than that of the control group 12 h after surgery, 24 h after surgery, 48 h after surgery than that of the control group(P<0.05). The incidence of adverse reactions in the observation group(13.00% vs 11.00%) was not statistically significant compared with the control group(P>0.05). Conclusion: The local incision infiltration injection of 0.5% ropivacaine combined with analgesia pump after analgesia can accelerate the recovery after obstetrics, promote early lactation, reduce postoperative pain, reduce pain stress reaction, with fewer adverse reactions. Therefore, it is an effective analgesia method after cesarean section.