右美托咪定复合舒芬太尼对剖宫产术术后疼痛及炎性反应的影响
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摘要
目的:探讨盐酸右美托咪定复合舒芬太尼在剖宫产术后自控镇痛中的效果以及对血清炎性细胞因子表达的影响。方法:选取2017年7月～2018年6月在宿州市立医院行剖宫产的孕妇100例,随机分为对照组和观察组各50例,对照组采用输注舒芬太尼进行自控镇痛(PCIA),观察组采用右美托咪定复合舒芬太尼进行自控镇痛(PCIA)。比较两组患者术后不同时间点的视觉模拟疼痛(VAS)评分、舒芬太尼用量、术后不良反应发生率、血清C反应蛋白(CRP)、肿瘤坏死因子-α(TNF-α)、白细胞介素-10(IL-10)含量。结果:术后12、24、48 h,观察组产妇的VAS评分均低于对照组(P<0.05);术后12 h,观察组产妇的舒芬太尼用量、自控镇痛泵的按压次数低于对照组(P<0.05);两组产妇的恶心呕吐、低氧血症、术后延迟恢复差异均无统计学意义(P>0.05),但观察组术后躁动低于对照组(P<0.05);两组产妇术后12 h的血浆CRP、TNF-α、IL-10含量较组内术前均提高(P<0.05),且观察组产妇的CRP、TNF-α、IL-10提高幅度低于对照组(P<0.05)。结论:剖宫产术后右美托咪定复合舒芬太尼可减少炎症介质的释放,提高镇痛效果,促进产后恢复。
Objective:To investigate the clinical efficacy of dexmedetomidine hydrochloride combined with sufentanil in analgesic and the effect on the expression of plasma inflammatory cytokine level in women following cesarean section.Methods:One hundred women undergone cesarean section in Suzhou Municipal Hospital were included from July 2017 to June 2018,and equally randomized into control group and the observational group.Women in the control group were treated with sufentanil via patient-controlled intravenous analgesia(PICA),and those in observational group were managed with dexmedetomidine plus sufentanil for PICA.The two groups were compared concerning visual analogue scores(VAS),sufentanil dosage,postoperative adverse reactions,plasma c-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α) and interleukin-10(IL-10) at different time points following operation.Results:Women in the observational group had lower VAS scoring at 12 h,24 h and 48 h after surgery(P<0.05)as well as lower sufentanil dose and frequencies of PICA than those in the control group at postoperative 12 h(P<0.05).The difference was insignificant in nausea,vomiting,hypoxemia and delayed postoperative recovery between groups(P>0.05).Women in the observational group had significantly lower postoperative restlessness than those in the control group(P<0.05).Markedly elevated CRP,TNF-α and IL-10 levels at 12 h after surgery were seen in both groups,yet the increase of CRP,TNF-α and IL-10 was more obvious in the observational group(P<0.05).Conclusion:Combined dexmedetomidine with sufentanil can reduce the release of inflammatory mediators,and significantly improve the analgesic effect and promote postpartum recovery for women following cesarean section.
Objective:To investigate the clinical efficacy of dexmedetomidine hydrochloride combined with sufentanil in analgesic and the effect on the expression of plasma inflammatory cytokine level in women following cesarean section.Methods:One hundred women undergone cesarean section in Suzhou Municipal Hospital were included from July 2017 to June 2018,and equally randomized into control group and the observational group.Women in the control group were treated with sufentanil via patient-controlled intravenous analgesia(PICA),and those in observational group were managed with dexmedetomidine plus sufentanil for PICA.The two groups were compared concerning visual analogue scores(VAS),sufentanil dosage,postoperative adverse reactions,plasma c-reactive protein(CRP),tumor necrosis factor-alpha(TNF-α) and interleukin-10(IL-10) at different time points following operation.Results:Women in the observational group had lower VAS scoring at 12 h,24 h and 48 h after surgery(P<0.05)as well as lower sufentanil dose and frequencies of PICA than those in the control group at postoperative 12 h(P<0.05).The difference was insignificant in nausea,vomiting,hypoxemia and delayed postoperative recovery between groups(P>0.05).Women in the observational group had significantly lower postoperative restlessness than those in the control group(P<0.05).Markedly elevated CRP,TNF-α and IL-10 levels at 12 h after surgery were seen in both groups,yet the increase of CRP,TNF-α and IL-10 was more obvious in the observational group(P<0.05).Conclusion:Combined dexmedetomidine with sufentanil can reduce the release of inflammatory mediators,and significantly improve the analgesic effect and promote postpartum recovery for women following cesarean section.
引文
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[10] CHEN XX,WANG T,LI J,et al.Relationship between inflammatory response and estimated complication rate after total hip arthroplasty[J].Chinese Medical Journal,2016,129(21):2546-2551.
[11] ASL ME,ISAZADEFAR K,MOHAMMADIAN A,et al.Ondansetron and meperidine prevent postoperative shivering after general anesthesia[J].Middle East Journal of Anesthesiology,2011,21(1):67-70.
[12] RYAN S,TAYLOR CT,MCNICHOLAS WT.Predictors of elevated nuclear factor-κb-dependent genes in obstructive sleep apnea syndrome[J].American Journal of Respiratory & Critical Care Medicine,2006,174(7):824.
[13] FENG XJ,HU XY,ZHANG S,et al.Effects of the dexmedetomidine,midazolam,butorphanol,and atropine combination on plasma oxidative status and cardiorespiratory parameters in raccoon dogs (Nyctereutes procyonoides)[J].Veterinární Medicína,2015,60(8):450-455.
[14] KUMI M,YUKI O,AKIRA M,et al.Intrathecal administration of morphine decreases persistent pain after cesarean section:a prospective observational study[J].Plos One,2016,11(5):e0155114.
[15] 张运琼,刘英,刘志莲,等.舒芬太尼复合右美托咪定在肺癌手术患者术后镇痛中的效果及对疼痛介质表达的影响[J].海南医学,2018(4):462-465.
[16] WEERINK MAS,STRUYS MMRF,HANNIVOORT LN,et al.Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J].Clinical Pharmacokinetics,2017,56(8):893-913.
[2] MUELLER N T,WHYATT R,HOEPNER L,et al.Prenatal exposure to antibiotics,cesarean section and risk of childhood obesity[J].International Journal of Obesity,2015,39(4):665-670.
[3] DEHUA K,JIANHUA B,SUQIAO M,et al.Effects of dexmedetomidine hydrochloride on hemodynamics,postoperative analgesia and cognition in cesarean section[J].Experimental and Therapeutic Medicine,2018,16(3):1778-1783.
[4] VOGEL J P,BETIAN,ANA PILAR,VINDEVOGHEL N,et al.Use of the Robson classification to assess caesarean section trends in 21 countries:a secondary analysis of two WHO multicountry surveys[J].Lancet Global Health,2015,3(5):e260-e270.
[5] 何冰君,曹睿.剖宫产妇疼痛及产后康复的影响因素分析及临床干预[J].西部医学,2016,28(10):1474-1477.
[6] AFOLABI BB,LESI FE.Regional versus general anaesthesia for caesarean section[J].Anaesthesia,1994,49(1):CD004350.
[7] HOFMEYR G,BARRETT J,CROWTHER C.Planned caesarean section for women with a twin pregnancy[J].Cochrane Database of Systematic Reviews,2015,12(12):CD006553.
[8] WUJUN G,WANDONG H,JUNLU W,et al.Flurbiprofen axetil enhances analgesic effects of sufentanil and attenuates postoperative emergence agitation and systemic proinflammation in patients undergoing tangential excision surgery[J].Mediators of Inflammation,2015,2015:1-6.
[9] MUZII L,DOMENICI L,LECCE F,et al.Clinical outcomes after resectoscopic treatment of cesarean-induced isthmocele:a prospective case-control study[J].Eur Rev Med Pharmacol Sci,2017,21(15):3341-3346.
[10] CHEN XX,WANG T,LI J,et al.Relationship between inflammatory response and estimated complication rate after total hip arthroplasty[J].Chinese Medical Journal,2016,129(21):2546-2551.
[11] ASL ME,ISAZADEFAR K,MOHAMMADIAN A,et al.Ondansetron and meperidine prevent postoperative shivering after general anesthesia[J].Middle East Journal of Anesthesiology,2011,21(1):67-70.
[12] RYAN S,TAYLOR CT,MCNICHOLAS WT.Predictors of elevated nuclear factor-κb-dependent genes in obstructive sleep apnea syndrome[J].American Journal of Respiratory & Critical Care Medicine,2006,174(7):824.
[13] FENG XJ,HU XY,ZHANG S,et al.Effects of the dexmedetomidine,midazolam,butorphanol,and atropine combination on plasma oxidative status and cardiorespiratory parameters in raccoon dogs (Nyctereutes procyonoides)[J].Veterinární Medicína,2015,60(8):450-455.
[14] KUMI M,YUKI O,AKIRA M,et al.Intrathecal administration of morphine decreases persistent pain after cesarean section:a prospective observational study[J].Plos One,2016,11(5):e0155114.
[15] 张运琼,刘英,刘志莲,等.舒芬太尼复合右美托咪定在肺癌手术患者术后镇痛中的效果及对疼痛介质表达的影响[J].海南医学,2018(4):462-465.
[16] WEERINK MAS,STRUYS MMRF,HANNIVOORT LN,et al.Clinical pharmacokinetics and pharmacodynamics of dexmedetomidine[J].Clinical Pharmacokinetics,2017,56(8):893-913.