地佐辛联合舒芬太尼用于剖宫产术后镇痛对母婴的影响
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摘要
目的探讨地佐辛联合舒芬太尼用于剖宫产术后镇痛对产妇催乳素水平及新生儿的影响。方法按随机数字表法将300例行剖宫产术的产妇分为A组(舒芬太尼2μg/kg术后镇痛)、B组(地佐辛0.15 mg/kg+舒芬太尼2μg/kg术后镇痛)、C组(地佐辛0.3 mg/kg+舒芬太尼2μg/kg术后镇痛),各100例。术后4,8,12,24,36 h,对产妇进行疼痛视觉模拟评分法(VAS)评分,测定血浆催乳素水平,对新生儿进行神经和适应能力评分(NACS);观察术后48 h内3组产妇不良反应的发生情况。结果术后4,8,12,24 h,B组和C组的VAS评分均显著低于A组(P <0.05),且C组明显低于B组(P <0.05);术后12,24,36 h,B组和C组的催乳素水平显著高于A组(P <0.05),且C组显著高于B组(P <0.05);术后各时段各组新生儿NACS评分无显著差异(P> 0.05); A组术后恶心、呕吐、头晕、嗜睡等不良反应发生率显著高于B组和C组(P <0.05),但B组和C组无显著差异(P> 0.05)。结论与单用舒芬太尼相比,地佐辛联合舒芬太尼术后镇痛效果更佳,且联合用药中地佐辛用量为0.3 mg/kg时的镇痛效果优于其用量为0.15 mg/kg时,可促进乳汁分泌,对新生儿无不良影响,且产妇不良反应发生率低。
Objective To investigate the effect of postoperative analgesia with dezocine combined with sufentanil on prolactin levels in puerperae undergoing cesarean section and neonates.Methods According to the random number table method,300 puerperae undergoing cesarean section were divided into group A(sufentanil 2 μg/kg for postoperative analgesia),group B(dezocine 0.15 mg/kg + sufentanil 2 μg/kg for postoperative analgesia) and group C(dezocine 0.3 mg/kg + sufentanil 2 μg/kg for postoperative analgesia),100 cases in each group.At 4,8,12,24,36 h after the operation,the visual analogue scale(VAS) score of puerperae was measured and the plasma prolactin levels of puerperae were determined.The neurologic and adaptive capacity scores(NACS) of neonates were scored,and the adverse reactions within 48 h after the operation in the three groups were observed.Results At 4,8,12,24 h after the operation,the VAS scores of group B and group C were significantly lower than those of group A(P < 0.05),and those in group C were significantly higher than those of group B(P < 0.05).At 12,24,36 h after operation,the prolactin levels of group B and group C were significantly higher than those of group A(P < 0.05),and those in group C were significantly higher than those of group B(P < 0.05).There was no significant difference in the neonatal NACS score during different periods(P > 0.05).After the operation,the incidence rates of adverse reactions,such as nausea,vomiting,dizziness,and drowsiness in group A were significantly higher than those in group B and group C(P < 0.05),but there was no significant difference between group B and group C(P > 0.05).Conclusion Compared with the single use of sufentanil,dezocine combined with sufentanil for postoperative analgesia has better effect,and the analgesic effect of dezocine at the dosage of 0.3 mg/kg was better than that at the dosage of 0.15 mg/kg,it can promote the secretion of milk,without adverse effect on neonates,and the incidence rate of adverse reactions for puerperae is low.
Objective To investigate the effect of postoperative analgesia with dezocine combined with sufentanil on prolactin levels in puerperae undergoing cesarean section and neonates.Methods According to the random number table method,300 puerperae undergoing cesarean section were divided into group A(sufentanil 2 μg/kg for postoperative analgesia),group B(dezocine 0.15 mg/kg + sufentanil 2 μg/kg for postoperative analgesia) and group C(dezocine 0.3 mg/kg + sufentanil 2 μg/kg for postoperative analgesia),100 cases in each group.At 4,8,12,24,36 h after the operation,the visual analogue scale(VAS) score of puerperae was measured and the plasma prolactin levels of puerperae were determined.The neurologic and adaptive capacity scores(NACS) of neonates were scored,and the adverse reactions within 48 h after the operation in the three groups were observed.Results At 4,8,12,24 h after the operation,the VAS scores of group B and group C were significantly lower than those of group A(P < 0.05),and those in group C were significantly higher than those of group B(P < 0.05).At 12,24,36 h after operation,the prolactin levels of group B and group C were significantly higher than those of group A(P < 0.05),and those in group C were significantly higher than those of group B(P < 0.05).There was no significant difference in the neonatal NACS score during different periods(P > 0.05).After the operation,the incidence rates of adverse reactions,such as nausea,vomiting,dizziness,and drowsiness in group A were significantly higher than those in group B and group C(P < 0.05),but there was no significant difference between group B and group C(P > 0.05).Conclusion Compared with the single use of sufentanil,dezocine combined with sufentanil for postoperative analgesia has better effect,and the analgesic effect of dezocine at the dosage of 0.3 mg/kg was better than that at the dosage of 0.15 mg/kg,it can promote the secretion of milk,without adverse effect on neonates,and the incidence rate of adverse reactions for puerperae is low.
引文
[1]刘兴进,谭玉元,杨捷.喷他佐辛静脉自控镇痛对剖宫产术后产妇泌乳素水平的影响[J].医学综述,2016,11(3):578-580.
[2]张骐,崔雯.盐酸羟考酮用于剖宫产术后静脉自控镇痛的疗效及对血泌乳素的影响[J].皖南医学院学报,2016,35(3):283-285.
[3]崔士和,蒋忠.等效镇痛剂量芬太尼、瑞芬太尼和舒芬太尼对维吾尔族患者镇静及副作用影响的对比研究[J].现代医学,2016,12(2):187-190.
[4]付来华,宋建民,梁鹏,等.地佐辛复合舒芬太尼在脊柱肿瘤手术后镇痛的效果评价[J].实用临床医药杂志,2016,20(17):163-164.
[5]李淑,邹振宇,宋仕钦.右美托咪定对剖宫产术后舒芬太尼静脉自控镇痛效果的影响[J].海南医学,2016,27(10):1631-1633.
[6]马青山,吴继勇,袁力勇.曲马多或左旋布比卡因切口浸润对全身麻醉剖宫产术后疼痛的影响[J].中国药业,2013,22(5):26-28.
[7]项雪琴.吗啡复合地佐辛用于剖宫产术后镇痛100例[J].中国药业,2013,22(11):147-149.
[8]李建春.腰硬麻醉联合地佐辛静脉自控镇痛对剖宫产术后镇痛及泌乳素的影响[J].中国妇幼保健,2017,32(22):5753-5756.
[9]孔建强,汪建胜.地佐辛不同给药方式对结肠癌术后镇痛效果及炎性反应的影响[J].中国药业,2015,24(16):41-43.
[10]宋国军.不同剂量地佐辛复合舒芬太尼用于腹腔镜卵巢囊肿剔除术的镇痛效果及对血清5-HT和PS的影响[J].解放军医药杂志,2017,29(12):104-108.
[11]陈敬锋,许礼旭,陈磊,等.舒芬太尼联合地佐辛对乳腺癌患者术后静脉自控镇痛的临床研究[J].中国临床药理学杂志,2016,32(15):1387-1389.
[12]林雅丽,丁艺,覃淼.舒芬太尼联合罗哌卡因术后镇痛对剖宫产产妇泌乳素的临床效果观察[J].河北医学,2017,23(6):948-951.
[13]LAKE SL,SCHOLLJEGERDES EJ,NAYIGIHUGU V,et al.Effects of body condition score at parturition and postpartum supplemental fat on adipose tissue lipogenic activity of lactating beef cows[J].Journal of Animal Science,2006,84(4):1038.
[14]雷鸣,苏映军,王钠,等.泌乳素及其受体的研究进展[J].现代生物医学进展,2016,16(10):1979-1983.
[15]徐铭军,姚尚龙.中国分娩镇痛现状分析与实施策略[J].中国医刊,2016,51(8):4-7.
[16]高海燕,刘功俭,刘万超,等.地佐辛联合舒芬太尼用于神经外科术后患者自控镇痛的效果[J].江苏医药,2017,43(11):787-789.
[2]张骐,崔雯.盐酸羟考酮用于剖宫产术后静脉自控镇痛的疗效及对血泌乳素的影响[J].皖南医学院学报,2016,35(3):283-285.
[3]崔士和,蒋忠.等效镇痛剂量芬太尼、瑞芬太尼和舒芬太尼对维吾尔族患者镇静及副作用影响的对比研究[J].现代医学,2016,12(2):187-190.
[4]付来华,宋建民,梁鹏,等.地佐辛复合舒芬太尼在脊柱肿瘤手术后镇痛的效果评价[J].实用临床医药杂志,2016,20(17):163-164.
[5]李淑,邹振宇,宋仕钦.右美托咪定对剖宫产术后舒芬太尼静脉自控镇痛效果的影响[J].海南医学,2016,27(10):1631-1633.
[6]马青山,吴继勇,袁力勇.曲马多或左旋布比卡因切口浸润对全身麻醉剖宫产术后疼痛的影响[J].中国药业,2013,22(5):26-28.
[7]项雪琴.吗啡复合地佐辛用于剖宫产术后镇痛100例[J].中国药业,2013,22(11):147-149.
[8]李建春.腰硬麻醉联合地佐辛静脉自控镇痛对剖宫产术后镇痛及泌乳素的影响[J].中国妇幼保健,2017,32(22):5753-5756.
[9]孔建强,汪建胜.地佐辛不同给药方式对结肠癌术后镇痛效果及炎性反应的影响[J].中国药业,2015,24(16):41-43.
[10]宋国军.不同剂量地佐辛复合舒芬太尼用于腹腔镜卵巢囊肿剔除术的镇痛效果及对血清5-HT和PS的影响[J].解放军医药杂志,2017,29(12):104-108.
[11]陈敬锋,许礼旭,陈磊,等.舒芬太尼联合地佐辛对乳腺癌患者术后静脉自控镇痛的临床研究[J].中国临床药理学杂志,2016,32(15):1387-1389.
[12]林雅丽,丁艺,覃淼.舒芬太尼联合罗哌卡因术后镇痛对剖宫产产妇泌乳素的临床效果观察[J].河北医学,2017,23(6):948-951.
[13]LAKE SL,SCHOLLJEGERDES EJ,NAYIGIHUGU V,et al.Effects of body condition score at parturition and postpartum supplemental fat on adipose tissue lipogenic activity of lactating beef cows[J].Journal of Animal Science,2006,84(4):1038.
[14]雷鸣,苏映军,王钠,等.泌乳素及其受体的研究进展[J].现代生物医学进展,2016,16(10):1979-1983.
[15]徐铭军,姚尚龙.中国分娩镇痛现状分析与实施策略[J].中国医刊,2016,51(8):4-7.
[16]高海燕,刘功俭,刘万超,等.地佐辛联合舒芬太尼用于神经外科术后患者自控镇痛的效果[J].江苏医药,2017,43(11):787-789.