不同浓度地佐辛复合曲马多用于剖宫产术后镇痛效果

Effect of different concentrations of dezocine combined with tramadol for postoperative analgesia of women after cesarean section and its influence on the pregnancy outcomes of women

目的:探究不同浓度地佐辛复合曲马多用于剖宫产术后镇痛效果。方法:选取2019年2月-2020年12月在本院行剖宫产术产妇168例,随机数字表法分为A、B1、B2、B3组各42例,均行硬膜外麻醉;在剖宫产术后A组给予曲马多7mg/kg镇痛,B1、B2、B3在A组基础上联合地佐辛,剂量分别为0.1、0.15、0.2mg/kg。比较4组产妇剖宫产后运动及静息状态下的VAS评分、Ramsay镇静评分、体征情况、睡眠质量(AIS评分)及不良反应。结果:T1、T2、T3及T4时刻,A组运动、静息状态VAS评分均最高,Ramsay镇静评分最低,其次为B1组、B2组、B3组(均P<0.05),但B2组与B3组无差异(P>0.05);T1、T2、T3及T4时刻血氧饱和度4组无差异(P>0.05),舒张压、收缩压、心率A组高于B1组、B2组、B3组,但B2组较B1组、B3组稳定。术前1d、术后1d、术后2d及术后3dAIS评分A组最高,其次为B1组、B3组、B2组,不良反应发生率A组(28.6%)高于B3组(16.7%)、B1组(9.5%)、B2组(4.7%)(P<0.05);新生儿不良结局总发生率B2组最低。结论:0.15mg/kg地佐辛复合曲马多对剖宫产术后患者的镇静镇痛效果最佳,药物安全性高,可提高产妇产后睡眠质量。

Objective:To investigate the effect of different concentrations of dezocine combined with tramadol for postoperative analgesia of women after cesarean section,and to study its influence on the pregnancy outcomes of women.Methods:A total of 168women who underwent cesarean section under epidural anesthesia were selected and divided into group A,group B1,group B2,and group B3(42cases in each group)according to random number table method,from February 2019to December 2020.The women in group A were given tramadol 7mg/kg for postoperative analgesia,and the women in group B1,group B2,and group B3were given tramadol 7mg/kg combined with desocine 0.1 mg/kg,0.15mg/kg,and 0.2mg/kg,respectively.The VAS score in exercise and resting state,Ramsay sedation score,physical signs,sleep quality(AIS score),and adverse reaction rate of the women after cesarean section were compared among the four groups.Results:The VAS score in exercise or resting state of the women in group A at T1,T2,T3,or T4was the highest,and Ramsay sedation score of the women in group A at T1,T2,T3,or T4was the lowest,and which of the women were followed by that of the women in group B1,group B2,and group B3(all P<0.05),but which of the women had no significant different between group B2and group B3(P>0.05).There was no significant difference in the blood oxygen saturation of the women at T1,T2,T3,and T4among the four groups(P>0.05).The values of diastolic blood pressure,systolic blood pressure,and heart rate of the women in group A were significantly higher than those of the women in group B1,group B2,and group B3,but which of the women in group B2were significantly more stable than those of the women in group B1and group B3.AIS scores of the women in group A in 1dbefore operation,1dafter operation,2dafter operation,or 3dafter operation was the highest,and which was followed by that of the women in group B1,group B3,and group B2.The incidence of adverse reactions(28.6%)of the women in group A was significantly higher than that(16.7%)of the women in group B3,that(9.5%)of the women in group B1,and that(4.7%)of the women in group B2(P<0.05).The total incidence of neonatal adverse outcomes in group B2was the lowest.Conclusion:0.15mg/kg dezocine combined with tramadol of the women after cesarean section has the highest effect of postoperative intravenous sedation and analgesia with higher safety,which can improve postpartum sleep quality of the women.