曲马多缓释片口服用于妊娠中期引产镇痛的可行性分析

Feasibility analysis of tramadol sustained-release tablets orally used in the second trimester induced labor analgesia

目的探讨曲马多缓释片口服在妊娠中期引产镇痛的可行性。方法选取西南交通大学附属医院及四川锦欣妇女儿童医院2020年1月至2021年12月收治的妊娠中期引产患者154例,按随机数字表法分为对照组和观察组,每组77例。对照组予常规产科处理;观察组在常规产科处理基础上于临产时开始口服曲马多缓释片。采用疼痛视觉模拟量表(VAS)评分评估患者临产时(T_(0))、临产后0.5 h(T_(1))、1 h(T_(2))、3 h(T_(3))及胎儿娩出后(T_(4))疼痛程度。记录总产程时间、出血量、住院费用、不良反应发生率。比较引产前及胎盘娩出后血清肿瘤坏死因子α(TNF-α)和白细胞介素6(IL-6)水平。结果观察组T_(1)~T_(4)时点VAS评分均低于对照组[(6.9±1.1)分比(7.4±1.8)分、(4.6±1.1)分比(7.8±1.1)分、(4.9±1.6)分比(7.6±1.1)分、(4.4±1.6)分比(7.1±0.9)分],差异均有统计学意义(均P<0.05)。观察组总产程时间短于对照组[(6.7±1.4)h比(7.6±1.2)h],差异有统计学意义(P<0.001);2组出血量、住院费用及不良反应发生率比较差异均无统计学意义(均P>0.05)。胎盘娩出后2组血清TNF-α、IL-6水平均高于引产前,但观察组均低于对照组(均P<0.05)。结论曲马多缓释片口服可用于妊娠中期引产镇痛,具有良好的镇痛效果,能缩短引产时间,经济方便,安全可靠。

Objective To investigate the feasibility of tramadol sustained-release tablets in the second trimester induced labor analgesia. Methods A total of 154 patients with the second trimester induced labor admitted to Affiliated Hospital of Southwest Jiaotong University and Sichuan Jinxin Women and Children Hospital from January 2020 to December 2021 were collected. They were randomly divided into the control group and the observation group, with 77 cases in each group. The control group was given rountine obstetric treatment, and the observation group was given tramadol sustained-release tablets orally based on rountine obstetric treatment. Visual analogue scale(VAS) was used to evaluate labor pain at the time of labor(T_(0)), 0.5 h(T_(1)), 1 h(T_(2)), 3 h(T_(3)) after labor and after fetal delivery(T_(4)). Total induced labor time, hemorrhage, hospitalization expenses and adverse reactions rate were recorded. Serum levels of tumor necrosis factor-α(TNF-α) and interleukin(IL-6) before labor and after placenta delivery were compared between the two groups. Results The VAS scores at T_(1)-T_(4) of the observation group were lower than those of the control group at each time point [(6.9±1.1) vs(7.4±1.8),(4.6±1.1) vs(7.8±1.1),(4.9±1.6) vs(7.6±1.1),(4.4±1.6) vs(7.1±0.9)](all P<0.05). The total induced labor time of the observation group was shorter than that of the control group [(6.7±1.4)h vs(7.6±1.2)h](P<0.001). There were no significant differences in hemorrhage, hospitalization expenses and adverse reactions rate between the two groups(all P>0.05). After placenta delivery, serum levels of TNF-α and IL-6 of both groups were higher than those before labor, while the levels of the observation group were lower than those of the control group(all P<0.05). Conclusions Tramadol sustained-release tablets orally can be used for induction of labor analgesia in the second trimester of pregnancy, with good analgesic effect, and can shorten the induced labor time. It is economical, convenient, safe and reliable.