氢吗啡酮与布托啡诺PCEA对剖宫产术后疼痛、体液免疫及泌乳影响的对比研究

Comparison of the effects of hydromorphone PCEA and butorphanol PCEA on pain,humoral immunity and lactation after cesarean section

目的比较氢吗啡酮与布托啡诺硬膜外患者自控镇痛(PCEA)对剖宫产术后疼痛、体液免疫及泌乳的影响。方法选取2019年3月至2020年10月该院收治的需要行PCEA的剖宫产患者118例,采用随机数字表法分为Q组(氢吗啡酮PCEA)和B组(布托啡诺PCEA),每组59例。对比两组患者术后4、8、12、24、48 h疼痛程度[疼痛视觉模拟评分(VAS)],术前和术后48 h体液免疫情况[免疫球蛋白A(IgA)、IgM、IgG水平],术后泌乳始动时间,术后48 h泌乳量情况以及不良反应发生率。结果Q组患者术后4、8、12、24、48 h VAS均明显低于B组,差异均有统计学意义(P<0.05);两组患者术后8、12、24、48 h VAS均明显高于术后4 h,两组患者术后12、24、48 h VAS均明显高于术后8 h,两组术后24、48 h VAS均明显高于术后12 h,两组术后48 h VAS均明显低于术后24 h,差异均有统计学意义(P<0.05)。两组患者术后48 h IgA、IgM、IgG水平均明显低于术前,Q组患者术后48 h IgA、IgM、IgG水平均明显高于B组,差异均有统计学意义(P<0.05)。Q组患者泌乳始动时间明显短于B组,术后48 h泌乳量充足率明显低于B组,不良反应发生率明显高于B组,差异均有统计学意义(P<0.05)。结论剖宫产术后采用氢吗啡酮PCEA相比布托啡诺PCEA更能有效减轻术后疼痛,减轻对体液免疫的抑制,泌乳始动时间较短,但布托啡诺PCEA术后48 h泌乳量充足率较高,不良反应发生率较低。

Objective To compare the effects of hydromorphone PCEA and butorphanol PCEA on pain,humoral immunity and lactation after cesarean section.Methods A total of 118 cases of cesarean section patients who need PCEA in this hospital from March 2019 to October 2020 were selected and randomly divided into group Q(hydromorphone PCEA)and group B(butorphanol PCEA),59 cases in each group.The degree of pain at 4,8,12,24 h and 48 h after operation,the humoral immunity before and 48h after operation,the onset time of lactation after operation,the lactation volume at 48 h after operation and the incidence of adverse reactions were compared between the two groups.Results The VAS scores at 4,8,12,24 h and 48 h after operation in group Q were lower than those in group B(P<0.05).The VAS scores at 8,12,24 h and 48 h after operation in both groups were higher than those at 4 h after operation(P<0.05).The VAS scores at 12,24 h and 48 h after operation in both groups were higher than those at 8 h after operation(P<0.05).The VAS scores at 24 h and 48 h after operation in both groups were higher than those at 12 h after operation(P<0.05).The VAS score at 48 hours after operation was lower than that at 24 h after operation in both groups(P<0.05).The levels of IgA,IgM and IgG 48 h after operation in both groups were lower than those before operation(P<0.05),and the levels of IgA,IgM and IgG 48 h after operation in group Q were higher than those in group B(P<0.05).The onset time of lactation in group Q was shorter than that in group B(P<0.05),but the adequacy rate of lactation 48h after operation was lower than that in group B(P<0.05).The incidence of postoperative adverse reactions in group Q was higher than that in group B(P<0.05).Conclusion PCEA with hydromorphone after cesarean section can effectively reduce postoperative pain,reduce the inhibition of humoral immune,and shorten the onset time of lactation,but PCEA with butorphanol after cesarean section has higher lactation adequacy rate 48 h after operation and less adverse reactions.