不同剂量羟考酮硬膜外注射预防剖宫产牵拉反应的安全性和有效性分析  

Safety and efficacy analysis of different doses of epidural oxycodone injection for prevention of traction reactions in cesarean sections

作　　者：韩顺宇 杨薇 曾涛[1] 谢玉梅 陈丹丹[1] 刘永峰 HAN Shunyu;YANG Wei;ZENG Tao;XIE Yumei;CHEN Dandan;LIU Yongfeng(Department of Anesthesiology,Sichuan Provincial People′s Hospital Qionglai Hospital,Qionglai Medical Center Hospital,Chengdu 611530;Department of Thoracic Surgery,Sichuan Academy of Medical Sciences-Sichuan Provincial People′s Hospital,Chengdu 610000,China)

机构地区：[1]四川省人民医院邛崃医院/邛崃市医疗中心医院麻醉科,四川成都611530 [2]四川省医学科学院四川省人民医院胸外科,四川成都610000

出　　处：《基础医学与临床》2025年第2期216-221,共6页Basic and Clinical Medicine

基　　金：白求恩公益基金会恩泽疼痛管理医学研究项目(ezmr2023-051)。

摘　　要：目的本研究旨在通过分析不同剂量羟考酮硬膜外注射预防剖宫产术中牵拉反应的安全性和有效性,以明确羟考酮硬膜外注射预防剖宫产牵拉反应的最佳剂量。方法选取2023年10月至2024年5月期间本院收治欲行剖宫产分娩的产妇119例,随机分为A、B、C、D组,四组产妇均在胎儿娩出断脐后硬膜外注射给药,A、B、C组分别给予羟考酮3 mg、5 mg、7 mg,D组注射等量0.9%氯化钠溶液。比较四组产妇给药前5 min(T0)、给药后5 min(T1)、给药后10 min(T2)和给药后20 min(T3)的平均动脉压(MAP)、脉搏(P)、呼吸(RR)、脉搏血氧饱和度(SpO2)、术中牵拉反应分级、麻醉持续时间、术后48 h内患者自控静脉镇痛(PCIA)按压次数及术后24 h内不良反应。结果四组患者术中T0、T1、T2、T3的生命体征比较,差异无统计学意义,A、B、C组术中牵拉反应发生率分别为20%、17.2%、3.3%显著低于D组53.3%(P<0.05),且C组牵拉反应发生率显著低于A组(P<0.05)。A、B、C组麻醉持续时间显著长于D组(P<0.05),A组和C组PCIA按压次数显著低于D组(P<0.05),但C组不良反应总体发生率30%显著高于A组(0)和D组(6.7%)(P<0.05)。结论3 mg、5 mg、7 mg羟考酮硬膜外注射均可明显的减少剖宫产术中牵拉反应,对术中生命体征影响小,延长麻醉持续时间。其中,硬膜外注射7 mg羟考酮预防术中牵拉反应的效果最好,还可以减少术后PCIA的按压次数,但术后不良反应发生率较高,需要术后密切监护。Objective To evaluate the safety and effectiveness of different doses of epidural oxycodone injection for traction reaction during cesarean sections to determine the optimal dose.Methods Totally 119 cases of parturients who underwent cesarean sections from October 2023 to May 2024 were selected and randomly divided into groups A,B,C and D.All four groups of lying-in women received epidural injection after the umbilical cord was cut.Groups A,B and C were given oxycodone 3 mg,5 mg and 7 mg respectively,and group D was given an equal amount of normal saline.The primary outcomes were documentation of maternal vital signs and traction reaction during the surgery.Secondary outcomes included patient-controlled intravenous analgesia(PCIA)times within 48 hours and documentation of any postoperative adverse events within 24 hours.Results The comparison of intra-operative vital signs among the four groups of patients revealed no statistically significant differences.In groups A,B and C the incidence of traction reactions was significantly lower at 20%,17.2%and 3.3%,respectively,compared to group D at 53.3%,showing statistically significant differences(P<0.05).Additionally,the incidence of traction reaction in group C was significantly lower than in group A(P<0.05).Groups A,B and C produced significantly better results than group D in terms of the duration of anesthesia.PCIA presses were substantially less in groups A and C than in group D(P<0.05),and group C had a significantly higher total incidence of adverse events than group A and group D(P<0.05).Conclusions Epidural injection of 3 mg,5 mg and 7 mg oxycodone has been proved to significantly reduce traction reaction during cesarean sections while minimally impacting intraoperative vital signs.This intervention has the potential to extend the duration of anesthesia,decrease the frequency of PCIA presses.Among these,7 mg is the most effective but has the highest incidence of adverse effects,requiring carefully post-operative monitoring.

关 键 词：羟考酮 剖宫产 牵拉反应 内脏痛 椎管内麻醉 

分 类 号：R614[医药卫生—麻醉学]