盐酸氢吗啡酮超前镇痛对剖宫产术后血清TNF-α、SP表达及VAS评分的影响

Effects of hydromorphone hydrochloride preemptive analgesia on serum TNF-α,SP expressions and VAS score after cesarean section

目的探究盐酸氢吗啡酮超前镇痛对剖宫产术后血清肿瘤坏死因子-α(TNF-α)、P物质(SP)表达及疼痛视觉模拟量表(VAS)评分的影响。方法前瞻性选取2018年4月至2019月12月中山市人民医院收治的130例行剖宫产术患者,按照随机数字表法分为研究组及对照组,各65例。其中研究组给予盐酸氢吗啡酮超前镇痛,对照组给予等量0.9%氯化钠溶液注射。比较2组气管导管拔管后6(T1)、12(T2)、24 h(T3)镇痛效果;观察2组手术开始切皮时麻醉平面、麻醉初始平面;比较2组麻醉前(t1)、切皮后10 min(t2)、气管导管拔出后10 min(t3)时血清因子水平[TNF-α、白细胞介素-6(IL-6)、SP],免疫球蛋白[免疫球蛋白G(IgG)、免疫球蛋白M(IgM)、免疫球蛋白A(IgA)]水平,术后6、24 h时镇静评分(Ramsay)、新生儿Apgar评分等。结果 T1时,2组VAS评分基本维持在3分以下,组间比较差异无统计学意义(P>0.05);T2、T3时,研究组VAS评分显著低于对照组,差异有统计学意义(P<0.05)。研究组手术开始切皮时麻醉平面、麻醉初始平面较对照组均明显缩小,差异有统计学意义(P<0.05)。2组t1时TNF-α、IL-6、SP水平比较,差异无统计学意义(P>0.05),T2、T3时,研究组TNF-α、IL-6、SP水平均明显低于对照组,差异均有统计学意义(P<0.05)。术后6 h,2组患者IgG、IgM、IgA水平比较,差异均无统计学意义(P>0.05),术后12 h,研究组IgG、IgM、IgA水平均明显高于对照组,差异均有统计学意义(P<0.05)。术后6 h,2组Ramsay评分比较,差异无统计学意义(P>0.05),术后12 h,研究组Ramsay评分明显低于对照组,差异有统计学意义(P<0.05);2组出生1、5min Apgar评分比较,差异无统计学意义(P>0.05)。结论盐酸氢吗啡酮超前镇痛用于剖宫产镇痛效果明显,可有效缩小麻醉平面,减轻炎症反应,提高免疫功能,改善镇静状态,且不会对新生儿身体状况有影响。

Objective To investigate the effects of preemptive analgesia with hydromorphone hydrochloride on the expressions of tumor necrosis factor-α(TNF-α),substance P(SP) and visual analogue scale(VAS) after cesarean section. Methods A total of 130 patients with cesarean section in Zhongshan people’s hospital from April 2018 to December 2019 were selected and divided into study group and control group according to the random number table,with 65 cases in each group. The study group was given preemptive analgesia with hydromorphone hydrochloride,and the control group was given equal amount of saline injection. The analgesic effects of 6(T1),12(T2) and 24 hours(T3) after extubation of the tracheal tube in the two groups were compared. Anesthesia level and initial anesthesia level at the beginning of the operation with a skin incision of the two groups were observed. The levels of serum factor [TNF-α,interleukin-6(IL-6),SP],immunoglobulin levels[immunoglobulin G(Ig G),immunoglobulin M(Ig M),immunoglobulin A(Ig A) ]before anesthesia(t1),10 minutes after skin incision(t2),and 10 minutes after tracheal tube removal(t3),Ramsay score at 6 and 24 h after surgery and neonatal Apgar score were compared between the two groups. Results At T1,the VAS scores of the two groups were basically maintained below 3 points,and there was no significant difference between the two groups(P>0.05);At T2 and T3,the VAS scores of the study group were significantly lower than those of the control group,and the differences were statistically significant(P<0.05). The anesthesia level and initial anesthesia level of the study group at the beginning of the operation with a skin incision were significantly smaller than those of the control group,the differences were statistically significant(P <0. 05). There was no significant difference in the levels of TNF-α,IL-6 and SP between the two groups at t1(P>0.05). At t2 and t3,the levels of TNF-α,IL-6 and SP in the study group were significantly lower than those in the control group,The differences were statistically significant(P<0.05). At 6 h after operation,there was no significant difference in the levels of Ig G,Ig M,and Ig A between the two groups(P> 0. 05),at 12 h after operation,the levels of Ig G,Ig M and Ig A in the study group were significantly higher than those in the control group,the differences were statistically significant(P<0.05). There was no significant difference in Ramsay score between the two groups at 6 h after operation(P>0.05),but the Ramsay score at 12 h after operation in the study group were significantly lower than those in the control group(P <0. 05). There was no significant difference in Apgar score between the two groups at 1 min and 5 min after birth(P>0.05). Conclusion Preemptive analgesia with hydromorphone hydrochloride for cesarean section has obvious analgesic effect,it can effectively reduce the anesthesia level,reduce inflammatory reaction,improve immune function,improve sedation state,and will not affect the physical condition of newborns.