椎管内超前镇痛对HBV感染产妇剖宫产术后炎症应激指标及肝功能的影响

Effect of intraspinal preemptive analgesia on inflammatory stress indexes and liver function of cesarean section parturients with HBV infection

目的 分析椎管内超前镇痛对乙型肝炎病毒(HBV)感染产妇剖宫产术后炎症应激指标及肝功能的影响。方法 选取2018年1月-2020年1月在海南省妇女儿童医学中心妇产科行剖宫产手术的180例HBV感染产妇为研究对象,将其随机分为研究组和对照组,每组各90例,对照组产妇采用腰硬联合麻醉和术后静脉自控镇痛,研究组产妇在此基础上经硬膜外导管应用盐酸氢吗啡酮进行超前镇痛。对两组产妇术后3 h时和术后24 h时的视觉模拟评分法(VAS)评分、Ramsay镇静评分进行评价和比较。对两组产妇进入手术室时和术后24 h时的血清白细胞介素(IL)-6、肿瘤坏死因子(TNF)-α、肾上腺素(E)、去甲肾上腺素(NE)、多巴胺(DA)、丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)水平及HBV脱氧核糖核酸(DNA)载量进行比较。结果 在术后3 h时和术后24 h时,研究组产妇VAS评分下降幅度高于对照组(P<0.05)。在术后24 h,研究组产妇的血IL-6、TNF-α、E、DA、NE、ALT、AST水平变化幅度均小于对照组(P<0.05)。结论 在针对HBV感染产妇剖宫产手术中应用阿片类药物进行椎管内超前镇痛,可显著提升镇痛效果,有效降低产妇术后炎症应激水平和肝功能损害程度。

OBJECTIVE To observe the effect of intraspinal preemptive analgesia on inflammatory stress indexes and liver function of cesarean section parturients with hepatitis B virus(HBV) infection. METHODS A total of 180 parturients with HBV infection who underwent cesarean section in department of obstetrics and gynecology of Hainan Women’s and Children’s Medical Center from Jan 2018 to Jan 2020 were recruited as the study subjects and randomly divided into the study group and the control group, with 90 cases in each group. The control group was treated with spinal-epidural anesthesia and postoperative patient-controlled intravenous analgesia, while the study group was given additional hydromorphone hydrochloride injection for preemptive analgesia through epidural catheter on basis of the treatment of the control group. The visual analogue scale(VAS) score and the Ramsay sedation score were observed and compared between the two groups of parturients after surgery for 3 and 24 hours. The levels of serum interleukin(IL-6), tumor necrosis factor(TNF)-α,epinephrine(E), norepinephrine(NE), dopamine(DA), alanine aminotransferase(ALT) and aspartate aminotransferase(AST) as well as HBV deoxyribonucleic acid(DNA) load were observed and compared between the two groups of parturients at the time of surgery and after surgery for 24 hours. RESULTS The VAS scores were decreased significantly in the study group than in the control group after surgery for 3 and 24 hours(P<0.05). The levels of blood IL-6, TNF-α, E, DA, NE, ALT and AST changed less significantly in the study group than in the control group after the surgery for 24 hours(P<0.05). CONCLUSION The intraspinal preemptive analgesia with opioids for the cesarean section parturients with HBV infection can remarkably improve the effect of analgesia and effectively reduce the level of postoperative inflammatory stress and the degree of liver function damage.