阿片类镇痛药对剖宫产产妇术后镇痛影响因素分析  

Analysis of the influencing factors of opioid analgesics on postoperative pain after cesarean section

作　　者：王艳双 许晖雁 易杰[2] 车向明[1] 赵娜[1] 徐铭军[1] Wang Yanshuang;Xu Huiyan;Yi Jie;Che Xiangming;Zhao Na;Xu Mingjun(Department of Anesthesiology,Beijing Obstetrics and Gynecology Hospital,Capital Medical University,Beijing Maternal and Child Health Care Hospital,Beijing 100026,China;Department of Anesthesiology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京妇产医院,北京妇幼保健院麻醉科,北京100026 [2]中国医学科学院,北京协和医学院,北京协和医院麻醉科,北京100730

出　　处：《国际麻醉学与复苏杂志》2024年第6期607-612,共6页International Journal of Anesthesiology and Resuscitation

基　　金：中国产科麻醉和分娩镇痛及相关并发症调查研究(CMCHA-XM-2022-051)。

摘　　要：目的分析不同麻醉性镇痛药对剖宫产术后疼痛的影响。方法回顾性收集2022年6月至9月就诊于首都医科大学附属北京妇产医院满足纳入/排除标准的产妇共332例,采集产妇的基本信息、合并症、临床用药情况和术后镇痛随访记录等资料,应用单因素与多元线性回归分析对术后视觉模拟评分法(VAS)疼痛评分进行相关性分析。结果单因素分析结果显示,将吗啡应用剂量视为分类变量分析时,与未应用吗啡的产妇相比,应用吗啡2.0 mg产妇的VAS疼痛评分明显下降[比值比(OR)−0.8,95%置信区间(CI)−1.3~−0.2,P=0.009];将硬膜外应用吗啡的剂量按连续变量分析发现,随着吗啡剂量的增加,产妇术后VAS疼痛评分表现出下降趋势(β−0.4,95%CI−0.7~−0.1,P=0.011)。多元线性回归分析结果显示,调整身高、体重、年龄、术后应用患者自控硬膜外镇痛(PCEA)泵、妊娠合并高血压及糖尿病、术晨禁食水、术中出血及补液等变量,分别将吗啡剂量按照连续变量(β−0.5,95%CI−0.9~−0.2,P=0.003)和分类变量(OR−1.0,95%CI−1.7~−0.4,P=0.002)处理发现,吗啡单次硬膜外给药仍与VAS疼痛评分呈负相关。结论单次硬膜外给予吗啡2.0 mg可能是剖宫产术后VAS疼痛评分降低的独立影响因素。Objective To analyze the effect of different opioid analgesics on postoperative pain after cesarean section.Methods A total of 332 patients who were admitted to the Obstetrics and Gynecology Hospital of Capital Medical University from June to September 2022 and met the inclusion/exclusion criteria were enrolled for retrospective analysis.Their general information,comorbidity,clinical medication and postoperative analgesia follow-up records were collected.Then,univariate and multiple linear regression analyses were conducted for correlative analysis of postoperative Visual Analogue Scale(VAS)scores.Results The results of univariate analysis showed that when the dose of morphine was considered as a categorical variable,patients who received 2.0 mg of morphine showed significant decreases in VAS scores compared with those without morphine administration[odds ratio(OR)-0.8(95%confidence interval(CI)-1.3,-0.2),P=0.009].According to the doses of epidural morphine through continuous variable analysis,the postoperative VAS scores exhibited a decreasing trend with the increase of morphine dose[β-0.4(95%CI-0.7,-0.1),P=0.011].Multiple linear regression results indicated that,after adjustment of variables such as height,weight,age,patient-controlled epidural analgesia(PCEA)pump,pregnancy with hypertension and diabetes,water fasting in the morning,intraoperative bleeding and fluid rehydration,single epidural administration of morphine was still negatively correlated with VAS scores,when the dose of morphine was considered as a continuous variable[β-0.5(95%CI-0.9,-0.2),P=0.003]and a categorical variable[OR−1.0(95%CI−1.7,−0.4),P=0.002].Conclusion Single epidural administration of 2.0 mg morphine may be an independent factor for the reduction of VAS score after cesarean section.

关 键 词：剖宫产 麻醉性镇痛药 术后疼痛 影响因素 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]