羟考酮和舒芬太尼用于二次剖宫产术后的镇痛效果  

Effect of oxycodone and sufentanil on postoperative analgesia in patient undergoing repeated cesarean section

作　　者：朱延华 高亚川 陈春生 雷秀旺 耿春香 ZHU Yanhua;GAO Yachuan;CHEN Chunsheng(Department of Anesthesia,the Sixth People’s Hospital of Hengshui,Hebei,Hengshui 053200,China;不详)

机构地区：[1]河北省衡水市第六人民医院麻醉科,053200 [2]河北省衡水市第六人民医院骨科,053200 [3]河北省衡水市第六人民医院妇产科,053200

出　　处：《河北医药》2023年第2期249-251,255,共4页Hebei Medical Journal

基　　金：河北省医学科学研究课题计划(编号:20191092)。

摘　　要：目的 研究羟考酮和舒芬太尼在二次剖宫产术后镇痛的效果观察。方法 选择2018至2020年接受椎管内麻醉的二次剖宫产手术患者100例,随机分为对照组和试验组,每组50例,对照组采用硬膜外给予舒芬太尼80μg+1.192%甲磺酸罗哌卡因16 ml加NaCl溶液稀释到200 ml配泵(脉冲式输注泵),试验组采用硬膜外给予0.1 mg/ml羟考酮+1.192%甲磺酸罗哌卡因16 ml加NaCl溶液稀释到200 ml配泵(脉冲式输注泵)。2组通过硬膜外脉冲泵按照手术结束时给予5 ml负荷剂量,然后开启镇痛泵,给患者单次脉冲,脉冲剂量4 ml/次(1 s内将4 ml药量推注),锁定时间30 min,自控量3 ml。观察2组术后4、8、12、24、36 h各时间点患者切口痛,宫缩痛,下肢运动阻滞Bromage评分,患者自控镇痛(PCIA)次数、肛门排气时间、恶心呕吐、瘙痒各种并发症,患者的初乳时间和首次下床活动时间以及皮质醇的浓度(出手术室0 h、术后12、24 h)。结果 试验组产妇宫缩痛评分,术后并发症,产妇初乳时间和首次下床活动时间以及皮质醇浓度均低于对照组,差异有统计学意义(P<0.05),而2组下肢运动阻滞Bromage评分,差异无统计学意义(P>0.05)。结论 在二次剖宫产术后应用羟考酮和罗哌卡因硬膜外间歇脉冲输注镇痛,可有效阻止切口痛和宫缩痛,降低皮质醇浓度和应激反应,从而获得满意的镇痛效力,且术后相关不良反应少。Objective To observe the effect of oxycodone and sufentanil on postoperative analgesia in patient undergoing repeated cesarean section(RCS).Methods The patients(n=100) who underwent RCS under intraspinal anesthesia from 2017 to 2018 were randomly assigned into the control group(n=50) and the experimental group(n=50).Patients in the control group received epidural administration of sufentanil(80μg) + 1.192% ropivacaine mesylate(16ml) plus 200ml of diluted NaCl solution for pumping(pulsed infusion pump),and those in the experimental group received epidural administration of 0.1mg/ml oxycodone + 1.192% ropivacaine mesylate(16ml) plus 0ml of diluted NaCl for pumping(pulsed infusion pump).A loading dose of 5ml at the end of the operation through the epidural pulse pump was given to both groups,and then the extradural analgetic pump was turned on to apply a single pulse(pulse dose 4ml/time∶4ml was injected within 1s) with 30-min locking time and 3 ml of self-control volume.Incisional pain at 4h,8h,12h,24h and 36h,uterine contraction pain,Bromage score for lower extremity motor block,times of patient-controlled analgesia(PCA),anal exsufflation time,complication(nausea and vomiting,pruritus),time for colostrum,first out-of-bed activity time,and cortisol concentration at 0h,12h and 24h were compared.Results The uterine contraction pain score,postoperative complications,colostrum time,first out-of-bed activity time,and cortisol concentration in the experimental group were significantly lower than those in the control group(P<0.05).There was no significant difference in block Bromage score between groups(P>0.05).Conclusion The epidural intermittent pulse infusion of oxycodone and ropivacaine for analgesia after RCS can effectively prevent incision pain and uterine contraction pain,and reduce cortisol concentration and maternal stress response with less postoperative adverse events,thereby yielding a satisfactory analgesic effect.

关 键 词：舒芬太尼 羟考酮 硬膜外间隙脉冲输注技术 硬膜外术后镇痛 

分 类 号：R719.8[医药卫生—妇产科学]