地佐辛静脉用药联合罗哌卡因切口浸润对剖宫产术后宫缩痛及康复效果的影响  

Influence of intravenous administration of dezocine combined with incision infiltration with ropivacaine on uterine contraction pain and rehabilitation effect after cesarean section

作　　者：赵滨滨[1] 张丹琦[1] 刘嘉宁[2] 刘丕弘[1] 张素冰[1] 韩笑瑜 ZHAO Bin-bin;ZHANG Dan-qi;LIU Jia-ning(Department of Anesthesiology and Surgery,the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,Harbin Heilongjiang 150040,China;Department of Obstetrics,Heilongjiang Provincial Hospital,Harbin Heilongjiang 150036,China)

机构地区：[1]黑龙江中医药大学附属第一医院麻醉手术科,黑龙江哈尔滨150040 [2]黑龙江省医院产科,黑龙江哈尔滨150036 [3]黑龙江中医药大学附属第一医院骨伤科,黑龙江哈尔滨150040

出　　处：《临床和实验医学杂志》2023年第20期2238-2240,F0003,共4页Journal of Clinical and Experimental Medicine

基　　金：黑龙江省中医药科研项目(编号:ZHY2020-129)。

摘　　要：目的探究佐辛静脉用药联合罗哌卡因切口浸润对剖宫产术后宫缩痛及康复效果的影响。方法选取2020年9月至2022年9月黑龙江中医药大学附属第一医院行剖宫产的孕妇80例,进行前瞻性研究,按随机数字表法分为对照组和观察组,每组各40例。均行L_(2~3)腰硬联合麻醉实施手术,对照组剖宫产术缝合前给予地佐辛5 mg+舒芬太尼1μg/kg患者自控静脉镇痛(PICA)镇痛;观察组在对照组基础上联合切口皮下注射0.5%罗哌卡因15 mL进行局部浸润麻醉。比较两组术后宫缩痛评分、术后康复情况(下肢恢复活动时间、首次膀胱排尿时间、首次排气时间差异)、Ramsay镇静评分、镇痛药物使用情况、血清疼痛相关指标[血清肿瘤坏死因子α(TNF-α)、前列腺素E2(PGE2)]水平,并进行安全性评估。结果观察组术后6、12、24、48 h各时间点宫缩VAS评分分别为(1.70±1.09)、(2.75±0.87)、(2.63±0.98)、(1.98±0.80)分,均低于对照组[(2.10±0.87)、(3.20±0.79)、(3.25±0.78)、(2.38±1.17)分],差异均有统计学意义(P<0.05)。观察组术后首次下肢恢复活动时间、首次膀胱排尿时间、首次排气时间分别为(3.41±1.05)、(24.01±3.33)、(31.12±5.51)h,均短于对照组[(3.98±1.28)、(25.62±3.50)、(34.25±3.58)h],差异均有统计学意义(P<0.05)。两组术后48 h内各时间点的Ramsay镇静评分比较,差异均无统计学意义(P>0.05)。观察组PICA有效按压次数和补救镇痛发生率分别为(6.23±2.22)次、15.00%,均低于对照组[(8.93±2.68)次、47.50%],差异均有统计学意义(P<0.05)。观察组术后48 h的血清TNF-α、PGE2水平分别为(15.76±2.35)ng/L、(171.16±17.58)ng/L,均低于对照组[(19.79±2.80)ng/L、(187.85±14.05)ng/L],差异均有统计学意义(P<0.05)。观察组总不良反应发生率为12.50%,低于对照组(32.50%),差异有统计学意义(P<0.05)。结论地佐辛静脉用药联合罗哌卡因切口浸润能有效缓解剖宫产术后宫缩痛,缩短术后康�Objective To explore the influence of intravenous administration of dezocine combined with ropivacaine incision infiltration on uterine contraction pain and rehabilitation effect after caesarean section.Methods Eighty pregnant women who underwent cesarean section in the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine from September 2020 to September 2022 were prospectively selected.According to the random number table method,the patients were divided into control group and observation group,with 40 cases in each group.And all the women underwent surgery under L 2-3 combined spinal-epidural anesthesia.The control group received 5 mg of dexamethasone and 1 mg of sufentanil before cesarean section suturingμg/kg patient intravenous controlled analgesia(PCIA)analgesia,the observation group received local infiltration anesthesia by subcutaneous injection of 0.5%ropivacaine 15 mL into the incision on the basis of the control group.Postoperative uterine contraction pain score,Ramsay sedation score,levels of serum tumor necrosis factor-α(TNF-α)and prostaglandin E2(PGE2)and postoperative rehabilitation were compared between the two groups,and the safety was evaluated.Results The VAS scores for uterine contractions at 6,12,24,and 48 hours after surgery in the observation group were(1.70±1.09),(2.75±0.87),(2.63±0.98),and(1.98±0.80)points,respectively,which were lower than those in the control group[(2.10±0.87),(3.20±0.79),(3.25±0.78),and(2.38±1.17)points],and the differences were statistically significant(P<0.05).The first postoperative recovery time of lower limb activity,first bladder urination time,and first exhaust time in the observation group were(3.41±1.05),(24.01±3.33),and(31.12±5.51)h,respectively,which were shorter than those in the control group[(3.98±1.28),(25.62±3.50),and(34.25±3.58)h],and the differences were statistically significant(P<0.05).There was a statistical significance in Ramsay sedation score between the groups(P<0.05),but there was no statistical

关 键 词：剖宫产术 产后宫缩痛 康复效果 地佐辛 罗哌卡因 

分 类 号：R614[医药卫生—麻醉学]