剖宫产术硬膜外镇痛泵联合静脉镇痛对产妇炎性因子、凝血功能及应激反应的影响  

Effects of epidural analgesia pump combined with intravenous analgesia during cesarean section on their inflammatory factors,coagulation function,and stress response

作　　者：李晓瑜 王敏 陈运良[1] 李亚军 LI Xiaoyu;WANG Min;CHEN Yunliang;LI Yaju(Guang'an People's Hospital,Guang'an,Sichuan Province,638000)

机构地区：[1]四川省广安市人民医院,638000

出　　处：《中国计划生育学杂志》2023年第1期75-79,共5页Chinese Journal of Family Planning

摘　　要：目的:探究剖宫产术硬膜外镇痛泵联合静脉镇痛对产妇炎性因子、凝血功能及应激反应的影响。方法:选取2019年9月-2021年9月在本院择期行剖宫产术产妇106例,随机数字表法分为常规组(n=53,单用硬膜外镇痛泵镇痛)和联用组(n=53,硬膜外镇痛泵联合静脉镇痛)。比较两组围术期情况、术后疼痛评分(VAS)、镇痛前后炎症因子血清C反应蛋白(CRP)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、降钙素原(PCT)水平,凝血功能指标凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、纤维蛋白原(FIB)及D-二聚体(D-D)水平,应激反应指标血浆皮质醇(COR)、血管紧张素Ⅱ(Ang II)、肾上腺素(E)、去甲肾上腺素(NE)水平。结果:联用组首次下床活动时间(1.3±0.4d)短于常规组(1.6±0.4d),术后VAS评分4 h(2.14±0.39分)、8 h(2.56±0.51分)、12 h(3.03±0.45分)、24 h(2.87±0.73分)、48 h(2.34±0.35分)均低于常规组(2.68±0.42分、2.96±0.57分、3.32±0.43分、3.65±0.69分、2.81±0.46分)(均P<0.05);镇痛后联用组PT、APTT均长于常规组,FIB、D-D、CRP、IL-6、TNF-α、PCT、COR、Ang II、E及NE水平均低于常规组(P<0.05),两组并发症比较(18.9%、11.3%)无差异(P>0.05)。结论:硬膜外镇痛泵联合静脉镇痛减轻剖宫产产妇术后疼痛效果显著,在改善炎症反应、抑制高凝状态、缓解应激反应等方面更优。Objective:To explore the effects of epidural analgesia pump combined with intravenous analgesia for treating women during cesarean section on their inflammatory factors,coagulation function,and stress response.Methods:106 pregnant women who scheduled for cesarean section in the hospital were selected and were divided into two groups by random number table between September 2019 and September 2021.53 women in group A were given patient controlled epidural analgesia,53 women in group B were given patient controlled epidural analgesia combined with intravenous analgesia.The perioperative conditions,the postoperative pain score by visual analogue scale(VAS),the levels of serum C-reactive protein(CRP),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α),and procalcitonin(PCT),the values of coagulation function indicators,such as prothrombin time(PT),activated partial thromboplastin time(APTT),fibrinogen(FIB),and D-dimer(D-D),and the levels of stress response indicators,such as plasma cortisol(COR),angiotensin II(Ang II),epinephrine(E),and norepinephrine(NE)of the women were compared between the two groups.Results:The time(1.3±0.4d)of stay in bed of the women in group B was significantly shorter than that(1.6±0.4d)of the women in group A.The VAS score of the women in group B in postoperative 4 h(2.14±0.39 points),8 h(2.56±0.51 points),12 h(3.03±0.45 points),or 24 h(2.87±0.73 points),48 h(2.34±0.35 points)of the women in group B was significantly was lower than that(2.68±0.42 points,2.96±0.57 points,3.32±0.43 points,3.65±0.69 points,or 2.81±0.46 points)of the women in group A(all P<0.05).After analgesia,the values of PT and APTT of the women in group B were significantly longer than those of the women in group A,and the levels of FIB,D-D,CRP,IL-6,TNF-α,PCT,COR,Ang II,E,and NE of the women in group B were significantly lower than those of the women in group A(P<0.05).There was no significant difference in the complications rate(18.9%vs.11.3%)after analgesia of the women between the two groups(P>0.05).Conclus

关 键 词：剖宫产术 硬膜外镇痛泵 静脉镇痛 炎症因子 凝血功能 应激反应 

分 类 号：R614[医药卫生—麻醉学]