地佐辛在剖宫产术中的应用效果及其对应激反应和产后泌乳的影响

Application effect of dezocine during cesarean section and its influence on stress response and postpartum lactation

目的探讨地佐辛在腰硬联合麻醉剖宫产术中的应用效果及其对机体应激反应和产后泌乳的影响。方法选取2019年12月至2020年12月于中国人民解放军联勤保障部队第九六〇医院收治的90例行剖宫产术患者为研究对象,根据麻醉方法的不同将其分为观察组和对照组,各45例。观察组使用腰硬麻醉联合地佐辛静脉自控镇痛,对照组使用腰硬麻醉联合舒芬太尼静脉自控镇痛。分析比较两组患者术后2h、24h和48h的镇痛效果、术前、术毕和术后6h的应激反应、产后泌乳情况以及术后不良反应发生情况。结果观察组患者术后2h、24h和48h的Ramsay镇静评分均高于对照组(t值分别为7.159、9.257、12.870,P<0.05)。观察组患者术毕和术后6h的Cor、NE水平均低于对照组(t_(Cor)值分别为5.300、5.096;t_(NE)值分别为6.753、5.582,P<0.05)。观察组患者开始泌乳时间早于对照组,48h哺乳次数多于对照组(χ^(2)值分别为7.070、13.007,P<0.05)。观察组患者下肢麻木、尿潴留发生率低于对照组(P<0.05),但两组患者发生皮肤瘙痒、恶心呕吐、寒战的差异无统计学意义(P>0.05)。结论地佐辛在腰硬联合麻醉剖宫产术中的镇痛效果显著,可有效缓解机体应激反应,改善患者产后泌乳情况,减少部分术后不良反应。

Objective To explore the application effect of dezocine during cesarean section with combined spinal-epidural anesthesia and its influence on the body′s stress response and postpartum lactation.Methods A total of 90 patients undergoing cesarean section in the 960 th Hospital of the PLA Joint Logistics Support Force between December 2019 and December 2020 were selected as the subjects of the study.According to different anesthesia methods,they were divided into the observation group and the control group,with 45 cases in each group.The observation group was given combined spinal-epidural anesthesia combined with dezocine patient-controlled intravenous analgesia,and the control group received combined spinal-epidural anesthesia combined with sufentanil patient-controlled intravenous analgesia.The analgesic effect at 2 h,24 h and 48 h after surgery,stress response before surgery,at the end of surgery and at 6 h after surgery,postpartum lactation status and occurrence of postoperative adverse reactions were analyzed and compared between the two groups.Results At 2 h,24 h and 48 h after surgery,the Ramsay sedation scores in the observation group were higher than those in the control group(t=7.159,9.257 and 12.870,respectively,P<0.05).At the end of the surgery and at 6 h after surgery,the levels of Cor and NE were lower in the observation group than those in the control group(t_(Cor)=5.300 and 5.096,respectively,t_(NE)=6.753 and 5.582,respectively,P<0.05).The lactation starting time in the observation group was earlier than that in the control group,and the 48 h lactation frequency was more than that in the control group(χ^(2)=7.070 and 13.007,respectively,P<0.05).The incidences of lower limb numbness and urinary retention in the observation group were lower than those in the control group(P<0.05),but there were no statistical differences in the skin pruritus,nausea,vomiting and chills between the two groups(P>0.05).Conclusion Dezocine has a significant analgesic effect during cesarean section with combined spinal-epidural anesthesia,and it can effectively relieve the body′s stress response,improve the postpartum lactation status and reduce some postoperative adverse reactions.