慢性乙型肝炎剖宫产孕妇腰硬联合麻醉后应用羟考酮和吗啡术后镇痛效果及安全性对比  

Comparison of postoperative analgesic effect and safety between oxycodone and morphine for chronic hepatitis B pregnant women after cesarean section under combined spinal epidural anesthesia

作　　者：周伟[1] 夏继林 ZHOU Wei;XIA Jilin(Department of Surgical Anesthesiology,Ankang Maternal and Child Health Hospital,Shaanxi Province,Ankang 725000)

机构地区：[1]陕西省安康市妇幼保健院手术麻醉科,安康725000

出　　处：《陕西医学杂志》2020年第9期1161-1164,共4页Shaanxi Medical Journal

基　　金：陕西省安康市科学技术科研课题(2016AK-03-09)。

摘　　要：目的:对比慢性乙型肝炎(CHB)剖宫产孕妇腰硬联合麻醉后应用羟考酮和吗啡术后镇痛的效果及安全性。方法:收集行腰硬联合麻醉CHB剖宫产孕妇102例,根据术后镇痛方式的不同分为羟考酮组(53例)和吗啡组(49例)。羟考酮组予30 mg盐酸羟考酮+100 ml生理盐水,背景流量2 ml/h,自控镇痛剂量0.5 ml,锁定时间15 min,镇痛48 h。吗啡组予30 mg盐酸吗啡+100 ml生理盐水,设置同羟考酮组。对比两组孕妇术后4 h、8 h、12 h、24 h、48 h的视觉模拟(VAS)评分,以及术后镇痛满意度。于麻醉前、术后24 h、术后48 h采集两组孕妇血样,以化学发光法检测血清泌乳素(PRL)水平,对比两组孕妇术后恶心、呕吐、皮肤瘙痒、头晕、嗜睡等不良反应发生情况。结果:两组孕妇术后VAS评分随时间的延长呈逐渐下降趋势,羟考酮组孕妇术后4 h、8 h、12 h、24 h、48 h的VAS评分均显著低于吗啡组(均P<0.05)。羟考酮组总满意度为73.54%,明显高于吗啡组的53.06%(P<0.05),且羟考酮组对镇痛效果非常满意的孕妇比例显著高于吗啡组(P<0.05)。两组孕妇术后PRL水平随时间的延长呈逐渐上升趋势,且羟考酮组孕妇术后24 h、48 h的PRL水平均显著高于吗啡组(均P<0.05)。羟考酮组孕妇不良反应总发生率为16.98%,显著低于吗啡组的38.77%(P<0.05)。结论:CHB剖宫产孕妇腰硬联合麻醉后应用羟考酮的镇痛效果优于吗啡,能有效提高PRL水平,且安全性高。Objective:To compare the postoperative analgesia effect and safety between oxycodone and morphine for chronic hepatitis B(CHB)pregnant women after cesarean section under combined spinal epidural anesthesia(CSEA).Methods:A total of 102 CHB pregnant women who underwent cesarean section under CSEA were collected and divided into oxycodone group(53 cases)and morphine group(49 cases)according to different postoperative analgesia methods.Oxycodone group was given 30 mg oxycodone hydrochloride and 100 ml normal saline(2 ml/h background traffic,0.5 ml self-controlled analgesia dose,15 min locking time,analgesia for 48h).Morphine group was given 30 mg morphine hydrochloride and 100 ml normal saline(the set was the same with oxycodone group).At 4,6,12,24 and 48 hours after surgery,the VAS scores of pregnant women and the satisfaction of postoperative analgesia in both groups were compared.,The blood samples of pregnant women in both groups before anesthesia,at 24 and 48 hours after surgery were collected.The serum prolactin(PRL)level was detected by chemiluminescence method.The occurrence of adverse reactions such as nausea,vomiting,skin itch,dizziness and lethargy in both groups was compared.Results:The postoperative VAS scores in both groups were gradually decreased as time went by.At 4,6,12,24 and 48 hours after surgery,the VAS scores of oxycodone group were significantly lower than those of the morphine group(P<0.05).The total satisfaction rate of oxycodone group was significantly higher than that of the morphine group(73.54%vs.53.06%)(P<0.05).The proportion of pregnant women who were very satisfied with analgesic effect in the oxycodone group was significantly higher than that in the morphine group(P<0.05).The postoperative PRL level in both groups was gradually increased as time went by.At 24 and 48 hours after surgery,the PRL level of the oxycodone group was significantly higher than that of the morphine group(P<0.05).The incidence of adverse reactions in the oxycodone group was significantly lower than that in the

关 键 词：羟考酮 吗啡 慢性乙型肝炎 剖宫产 腰硬联合麻醉 镇痛 

分 类 号：R971[医药卫生—药品]