剖宫产术后应用右美托咪定复合布托啡诺镇痛效果及对受术者应激反应影响  

Effect of dexmedetomidine combined with butorphanol for postoperative analgesia of women after cesarean section and its influence on the stress response of these women

作　　者：李艳 田静 罗艳芝 LI Yan;TIAN Jing;LUO Yanzhi(Funan County People Hospital,Fuyang,Anhui Province,236300;The First Affiliated Hospital of Bengbu Medical College)

机构地区：[1]安徽省阜南县人民医院,236300 [2]蚌埠医学院第一附属医院

出　　处：《中国计划生育学杂志》2023年第2期353-357,共5页Chinese Journal of Family Planning

摘　　要：目的:探讨剖宫产术后右美托咪定复合布托啡诺自控镇痛镇痛效果及对产妇应激反应的影响。方法:选择2021年1月-2022年6月在本院择期行剖宫产手术产妇92例,随机数字表法均分为联合组(46例)和对照组(46例)。对照组术后自控镇痛给予10mg布托啡诺,联合组胎儿娩出断脐后静脉泵注右美托咪定0.5μg/kg,术后自控镇痛给予右美托咪啶0.2μg/kg/h复合10mg布托啡诺,比较两组剖宫产术后不同时点疼痛视觉模拟评分(VAS)和Ramsay评分以及应激反应指标,并记录术后不良反应情况。结果:剖宫产术毕时两组VAS评分、Ramsay评分以及血清应激反应指标均无差异(P>0.05),术后12h、24h和48h联合组VAS评分(2.03±0.54分、1.60±0.46分、1.27±0.45分)低于对照组(2.32±0.62分、1.95±0.5分、1.62±0.49分),Ramsay评分(2.02±0.46分、2.12±0.58分、2.71±0.59分)高于对照组(1.98±0.43分、2.53±0.61分、2.96±0.57分),术后12h血清去甲肾上腺素(272.20±24.84 pg/ml)、内皮素-1(73.32±10.05 pg/ml)和皮质醇(266.32±32.05 ng/ml)水平低于对照组(317.75±25.19 pg/ml、79.57±10.62 pg/ml、297.57±34.62 ng/ml),术后眩晕(10.9%)、恶心呕吐(4.4%)发生率低于对照组(32.6%、21.7%)(均P<0.05)。结论:剖宫产术后自控镇痛采用右美托咪定复合布托啡诺可取得满意的镇痛、镇静效果,减轻产妇术后应激反应,降低不良反应。Objective: To investigate the effect of dexmedetomidine combined with butorphanol for postoperative analgesia of women after cesarean section, and to study its influence on the stress response of these women. Methods: From January 2021 to June 2022, a total of 92 pregnant women who wanted elective cesarean section were selected and were randomly divided into two groups(46 cases in each group). The women in the control group were given 10mg butorphanol for postoperative self-controlled analgesia, and the women in the study group were given 0.5μg/kg dexmedetomidine by intravenous pump after baby delivery and then dexmedetomidine 0.2 μg/kg/h combined with 10mg butorphanol for postoperative self-controlled analgesia. The scores of visual analogue scales(VAS) and Ramsay, and stress response indexes of the women at different time points after cesarean section were compared between the two groups. And the situation of postoperative adverse reactions of the women in the two groups were recorded. Results: There were no significant differences in the scores of VAS and Ramsay, and the levels of serum stress response indexes of the women after cesarean section between the two groups(P>0.05). The VAS score of the women in the study group at postoperative 12h, 24h and 48h were 2.03±0.54 points, 1.60±0.46 points, and 1.27±0.45 points, respectively, which were significantly lower than those(2.32±0.62 points, 1.95±0.5 points, and 1.62±0.49 points) of the women in the control group.The Ramsay score of the women in the study group at postoperative 12h,24hand 48h were 2.02±0.46points,2.12±0.58points,and 2.71±0.59points,respectively,which were significantly higher than those(1.98±0.43points,2.53±0.61points,2.96±0.57points)of the women in the control group.The levels of serum norepinephrine(272.20±24.84pg/ml),endothelin-1(73.32±10.05pg/ml),and cortisol(266.32±32.05ng/ml)of the women in the study group at postoperative 12hwere significantly lower than those(317.75±25.19pg/ml and79.57±10.62pg/ml,and 297.57±34.62ng/ml

关 键 词：剖宫产 术后镇痛 右美托咪定 布托啡诺 应激反应 

分 类 号：R614[医药卫生—麻醉学]