氢吗啡酮静脉自控镇痛降低剖宫产术后疼痛及相关焦虑抑郁的发生

Analysis of Postoperative Analgesic and Antidepressant Effects of Patient-Controlled Intrave-nous Analgesia with Hydromorphone in Patients after Cesarean Section

目的:观察氢吗啡酮静脉自控镇痛对剖宫产术后患者急性、慢性疼痛及焦虑、抑郁的影响。方法:剖宫产初产妇339例纳入研究,随机分为舒芬太尼组和氢吗啡酮组,分别于术后给予舒芬太尼或氢吗啡酮行静脉内自控镇痛(PCIA)。采用数字评分法(NRS)评估产妇术后疼痛;手术后3个月电话访问患者是否存在慢性疼痛及疼痛评分。术前及术后1周使用医院焦虑和抑郁量表(HADS)评估焦虑和抑郁情况。采用Ramsay量表评估术后24 h镇静情况。记录2组不良反应;记录术后6 h和12 h的血流动力学及血氧饱和度。结果:与舒芬太尼组相比,氢吗啡酮组产妇术后6 h和12 h活动痛评分显著降低(P=0.001和P=0.033),术后48 h内各时间点宫缩痛评分显著低于舒芬太尼组(P<0.05);术后HADS焦虑和抑郁评分均显著低于舒芬太尼组(P<0.05);慢性疼痛发生率较低(P=0.047);而2组血流动力学、Ramsay镇静评分差异无统计学意义(P>0.05)。结论:氢吗啡酮静脉自控镇痛可显著缓解剖宫产术后产妇急性和慢性疼痛,尤其可缓解内脏痛,此外也可改善产妇焦虑、抑郁状况,效果优于舒芬太尼。在稳定血流动力学及不良反应方面,与舒芬太尼相当。

Objective:To compare the postoperative analgesic effects of patient-controlled intravenous analgesia(PCIA)with hydromorphone or sufentanil on acute and chronic pain,anxiety,and depression in patients after cesarean section.Methods:A cohort of 339 eligible parturients scheduled for cesarean section were randomly divided into two groups.Following cesarean section surgery,one group of parturients was administered PCIA comprising sufentanil(sufentanil group),while the other was administered PCIA comprising hydromorphone(hydromorphone group).The post-operative pain score was measured by the numeric rating scale(NRS);patients were followed up by phone 3 months after surgery for assessment of chronic pain.Anxiety and depression were evaluated before surgery and 1 week after surgery by the Hospital Anxiety and Depression Scale(HADS).The Ramsay sedation scale was used to assess sedation 24 hours after surgery.Adverse reactions were documented.The 6-hour and 12-hour post-operative hemodynamics data and blood oxygen saturation of the two groups were recorded.Results:Compared to the sufentanil group,the hydromorphone group showed significantly lower pain scores during physical activity at 6 h and 12 h after surgery(P=0.001 and P=0.033,respectively)and a significantly lower pain score of uterine contraction within 48 h after surgery(P<0.05).The hydromorphone group showed a significantly lower HADS score(P<0.05)and incidence of chronic pain(P=0.047)after surgery compared to the sufentanil group.There was no significant difference in hemodynamics and Ramsay sedation score between the two groups(P>0.05).Conclusion:Hydromorphone PCIA can reduce acute and chronic pain,particularly internal organ pain,after cesarean section;it also can improve symptoms of anxiety and depression.These effects are greater than that of sufentanil.Hydromorphone can stabilize hemodynamics and yields few adverse reactions similarly to sufentanil.