氢吗啡酮混合罗哌卡因硬膜外镇痛对剖宫产患者术后疼痛、炎症因子及产后抑郁的影响

Influence of hydromorphone mixed with ropivacaine epidural analgesia on postoperative pain,inflammatory factors and postpartum depression in cesarean section patients

目的 观察氢吗啡酮混合罗哌卡因对剖宫产患者术后疼痛、炎症因子及产后抑郁的影响的影响。方法 选择2020年1—6月本院产科择期行剖宫产产妇80例,单胎足月初产妇,年龄20~35岁,BMI 18.5~30 kg/m^(2),ASA分级I或Ⅱ级。采用随机数表法将患者均分为罗哌卡因组(对照组)和氢吗啡酮混合罗哌卡因组(观察组)两组,每组各40例。所有患者给予腰硬联合阻滞麻醉,术后均采用PCEA,观察组配方为氢吗啡酮3.0 mg+罗哌卡因300 mg共200 ml,对照组为罗哌卡因300 mg共200 ml。比较两组患者产后抑郁量表(Edinburgh postnatal depression scale,EPDS)评分、镇痛效果、不良反应以及静脉血中白细胞介素6(IL-6)、血清泌乳素(PRL)浓度。结果 与对照组相比,观察组产妇术后6 h、12 h、24 h、48 h各时点静息VAS评分均明显降低(P<0.05);术后48小时内观察组PCEA泵按压次数为(2.1±0.3)次,明显少于对照组的(6.4±1.0)次。与对照组比较,观察组术后3 d、6 d、42 d的EPDS评分明显降低(P<0.05),术后24 h、48 h观察组IL-6、TNF-α明显降低(P<0.05)。结论 氢吗啡酮混合罗哌卡因用于剖宫产术后镇痛可降低炎症反应,减轻患者产后抑郁。

Objective To observe the influence of hydromorphone mixed with ropivacaine on postoperative pain,inflammatory factors and postpartum depression in patients received caesarean section.Methods 80 cases of puerpera those underwent elective caesarean section in the obstetrics department of our hospital were enrolled as study subjects,all of which were single full term primipara,the age ranged from 20 to 35 years old,BMI ranged from 18.5 to 30 kg/m^(2),ASA grade I or Ⅱ.The patients were divide into two groups according to randomized number table method:ropivacaine group(control group) and hydromorphone mixed ropivacaine group(observation group),with 40 cases in each group.All patients were given combined lumbar and epidural block anesthesia,and PCEA was adopted after surgery.The formula of observation group was hydromorphone 3.0 mg and ropivacaine 300 mg in total 200 ml,and that of control group was ropivacaine 300 mg in total 200mL.The Edinburgh postnatal depression scale(EPDS) scores,analgesic effects,adverse reactions,and serum levels of interleukin 6(IL-6) and prolactin(PRL) in venous blood were compared between the two groups.Results Compared with the control group,the scores of resting VAS at 6h,12h,24h and 48h after surgery in the observation group were significantly decreased(P<0.05).The number of PCEA pump presses(2.1±0.3) in the observation group was significantly lower than that in the control group(6.4±1.0) within 48 hours after operation.Compared with the control group,the EPDS scores of the observation group were significantly decreased at 3d,6d and 42d after surgery(P<0.05),and IL-6 and TNF-α were significantly decreased at 24h and 48h after surgery(P<0.05).Conclusions Hydromorphone combined with ropivacaine for postoperative analgesia after cesarean section can reduce inflammatory response and alleviate postpartum depression.