罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果、术后恢复和血清炎症因子的影响

Effects of ropivacaine combined with dexmedetomidine on analgesic effect,postoperative recovery and serum inflammatory factors in parturients undergoing cesarean section

目的:探讨罗哌卡因联合右美托咪定对剖宫产产妇镇痛效果和术后恢复的影响。方法:按镇痛方案不同,将行116例剖宫产术的产妇分为对照组与试验组,每组各58例。对照组使用罗哌卡因+舒芬太尼镇痛;试验组使用罗哌卡因+右美托咪定镇痛。分别于术后3、6、12、24、及48 h,对产妇的疼痛程度进行评估;记录产妇术后镇痛泵使用情况;记录两组产妇阻滞时效和术后恢复相关指标;检测产妇术前及术后24 h血清白细胞介素6(IL-6)和肿瘤坏死因子α(TNF-α)水平;记录产妇术后48 h内不良反应发生情况。结果:两组术后3~48 h各时间点VAS评分、首次镇痛按压时间及术后48 h内镇痛泵按压次数差异均无统计学意义(P>0.05)。与对照组比较,试验组腰麻感觉阻滞达到最高平面经历的时间、感觉恢复时间较长(P<0.05),两组腰麻感觉阻滞起效时间无统计学差异(P>0.05)。与对照组相比,试验组首次肛门排气时间、泌乳始动时间均明显提前(P<0.05),48 h哺乳次数增多(P<0.05)。与对照组比较,试验组术后24 h血清IL-6、TNF-α水平更低(P<0.05),术后48 h内恶心呕吐发生率、皮肤瘙痒发生率更低(P<0.05)。结论:与罗哌卡因联合舒芬太尼比较,在腰硬联合麻醉中使用罗哌卡因联合右美托咪定也能够提供确切镇痛效果,且可减少不良反应,更能促进产妇术后恢复。

Objective:To investigate the effect of ropivacaine combined with dexmedetomidine on analgesia and postoperative recovery of parturients undergoing cesarean section.Methods:According to different analgesic schemes,116 parturients undergoing cesarean section were divided into control group and experimental group,with 58 cases in each group.The control group was treated with ropivacaine+sufentanil for anesthesia and analgesia,and the experimental group was treated with ropivacaine+dexmedetomidine for anesthesia and analgesia.The degree of pain was evaluated at 3,6,12,24 and 48 h after operation.The use of postoperative analgesia pump was recorded.The block time and the postoperative recovery indexes of the patients in the two groups were recorded.The serum levels of interleukin-6(IL-6)and tumor necrosis factor-α(TNF-α)were measured before and 24 hours after operation.In addition,adverse reactions within 48 hours after operation were recorded.Results:The VAS score at each time point from 3~48 h after operation,the time of first analgesic pressing and the number of times of analgesic pump pressing within 48 h after operation between two groups showed no significant difference(P>0.05).The time to reach the highest plane of spinal anesthesia sensation block and sensory recovery time of the experimental group were longer than those of the control group(P<0.05).There was no significant difference in the onset time of spinal anesthesia between the two groups(P>0.05).Compared with the control group,the first anal exhaust time and lactation initiation time of the experimental group were earlier(P<0.05),and the number of lactations in 48 h was increased(P<0.05).After 24 hours after operation,comparing with the control group,the levels of serum IL-6 and TNF-αin the experimental group were lower(P<0.05).Compared with the control group,the incidence of nausea and vomiting and skin itching in the experimental group decreased significantly within 48 hours after operation(P<0.05).Conclusion:Compared with ropivacaine combined with sufentanil,ropivacaine combined with dexmedetomidine for combined spinal-epidural anesthesia can provide exact postoperative analgesic effect,and reduce adverse reactions and promote maternal postoperative recovery.