羟考酮复合布托啡诺静脉自控镇痛对剖宫产术后宫缩痛的影响

Effect of PCIA of Oxycodone Combined with Butorphanol on Uterine Contraction Pain of Parturients After Cesarean Section

目的探讨羟考酮复合布托啡诺静脉自控镇痛(PCIA)对剖宫产术后宫缩痛、炎性细胞因子的影响。方法选取鄂州市妇幼保健院2019年7月至2020年6月收治的择期行剖宫产的产妇200例,随机分为对照组和观察组,各100例。胎儿娩出后,对照组产妇予静脉注射酒石酸布托啡诺注射液,观察组产妇予静脉注射盐酸羟考酮注射液,关腹时均连接PCIA泵。结果与对照组比较,观察组产妇术后4,8,16,24 h的切口痛与宫缩痛视觉模拟评分均显著降低,下肢恢复活动时间、恢复排尿时间、首次肛门排气时间、初乳时间均显著缩短,48 h内总哺乳次数显著增加(P<0.05);观察组产妇术后24 h的白细胞介素6、白细胞介素1β、肿瘤坏死因子-α水平均显著低于对照组,CD_(3)^(+)和CD_(4)^(+)水平及CD_(4)^(+)/CD_(8)^(+)均显著高于对照组(P<0.05);两组术后不良反应发生率无显著差异(P>0.05)。结论羟考酮复合布托啡诺PCIA用于剖宫产术后镇痛,可明显减轻切口痛及宫缩痛,且能有效下调炎性细胞因子水平,减轻术后的免疫抑制。

Objective To investigate the effect of patient-controlled intravenous analgesia(PCIA)of Oxycodone Injection combined with Butorphanol Injection on uterine contraction pain and inflammatory cytokines of parturients after cesarean section.Methods A total of 200 parturients who underwent elective cesarean section in the Ezhou Maternal and Child Health Hospital from July 2019 to June 2020 were selected and randomly divided into the control group and the observation group,with 100 cases in each group.After the fetus was delivered,the parturients in the control group were given Butorphanol Tartrate Injection intravenously,while the parturients in the observation group were given Oxycodone Hydrochloride Injection intravenously.When the abdomen was closed,PCIA pumps were performed on the patients in the two groups.Results Compared with those in the control group,the visual analogue scale(VAS)scores of incision pain and uterine contraction pain in the observation group were significantly lower at 4,8,16 and 24 h after operation,the recovery time of lower limbs activity,the recovery time of urination,the first anal exhaust time and the first lactation time in the observation group were significantly shorter,and the total times of breastfeeding within 48 h in the observation group were significantly more(P<0.05).The levels of interleukin(IL)-6,IL-1βand tumor necrosis factor-α(TNF-α)in the observation group were significantly lower than those in the control group,while the levels of CD_(3)^(+),CD_(4)^(+)and the CD_(4)^(+)/CD_(8)^(+)in the observation group were significantly higher than those in the control group(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion PCIA of oxycodone combined with butorphanol for postoperative analgesia after cesarean section can significantly inhibit incision pain and uterine contraction pain,effectively reduce the levels of inflammatory cytokines and reduce postoperative immunosuppression.