盐酸罗哌卡因复合氢吗啡酮腰椎麻醉在剖宫产手术中的应用

Application of ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia in cesarean section

目的探讨盐酸罗哌卡因复合氢吗啡酮腰椎麻醉在剖宫产手术中的价值。方法选择剖宫产产妇80例为研究对象,按照随机数字表法分为观察组和对照组,每组40例。对照组采用盐酸罗哌卡因腰椎麻醉,观察组采用盐酸罗哌卡因复合氢吗啡酮腰椎麻醉。比较2组产妇围手术期指标(手术时间、娩出时间、麻醉剂量、输液量、产后出血量)和麻醉效果,比较2组产妇术后不同时间疼痛视觉模拟(visual analogue scale,VAS)评分、镇静(Ramsay)评分,手术前后疼痛应激因子[P物质(substance P,SP)、神经肽Y(neuropeptide Y,NPY)、神经生长因子(nerve growth factor,NGF)和前列腺素E2(prostaglandin E2,PGE2)]水平及不良反应发生情况。结果2组手术时间、娩出时间、麻醉剂量、输液量和产后出血量差异无统计学意义(P>0.05)。观察组麻醉优良率显著高于对照组,差异有统计学意义(P<0.05)。2组VAS评分均呈逐渐降低趋势,观察组术后12、18 h评分低于对照组,组间、时点间、组间·时点间交互作用差异有统计学意义(P<0.05);2组Ramsay评分均呈先升高后降低趋势,时点间差异有统计学意义(P<0.05)、组间、组间·时点间交互作用差异无统计学意义(P>0.05)。术后,2组SP、NPY、NGF和PGE2均高于术前,观察组SP、NPY和PGE2低于对照组,差异有统计学意义(P<0.05),2组NGF差异无统计学意义(P>0.05)。2组不良发应总发生率差异无统计学意义(P>0.05)。结论盐酸罗哌卡因复合氢吗啡酮腰椎麻醉用于剖宫产手术,可提高麻醉效果,降低产妇疼痛程度和应激反应,不增加不良反应发生率,具有一定的临床应用价值。

Objective To explore the value of ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia in cesarean section.Methods A total of 80 cases of cesarean section women were selected as the research object,and they were divided into observation group and control group by random number method,with 40 cases each.The control group was treated with ropivacaine fine needle spinal anesthesia,and the observation group was combined with oxymorphone fine needle spinal anesthesia on the basis of the control group.The perioperative indicators(operation time,delivery time,anesthesia dose,infusion volume,postpartum hemorrhage volume)and anesthesia effect of the two groups of maternal patients were compare.The visual analogue pain(VAS)score and sedation(Ramsay)score of the two groups at different times were compared.And the difference of pain stress factors[substance P(SP),neuropeptide Y(NPY),nerve growth factor(NGF)and prostaglandin E2(PGE2)]before and after surgery were compared.And finally the adverse reactions of the two groups were counted.Results There were no significant differences in the operation time,delivery time,anesthesia dose,infusion volume,and postpartum hemorrhage in the observation group compared with the control group(P>0.05).The good rate of anesthesia in the observation group was significantly higher than that in the control group,and the difference was statistically significant(P<0.05).The VAS scores in the two groups were compared after operation,the difference was statistically significant(P<0.05).The observation group scores were significantly lower than the control group at 12 h and 18 h after operation,the difference was statistical significance(P<0.05);within two groups of Ramsay score comparisons were significantly higher after surgery,the difference was statistically significant(P<0.05).There was statistical significance between time points(P<0.05),but there was no significant difference in interaction between groups and time points(P>0.05).The postoperative SP,NPY and PGE2 in the observation group were significantly higher than those in the preoperative group and lower than those in the control group.The differences were statistically significant(P<0.05).Compared with the two groups before and after surgery,the NGF increased significantly with a statistically significant difference(P<0.05).There was no significant difference between the two groups before and after NGF surgery(P>0.05).The total incidence of adverse reactions was not statistically significant between two groups(P>0.05).Conclusion Ropivacaine hydrochloride combined with hydromorphone fine needle spinal anesthesia can be used in cesarean section to improve the effect of anesthesia,reduce maternal pain and stress reactions without increasing the incidence of adverse reactions.