酮咯酸氨丁三醇复合舒芬太尼用于剖宫产术后镇痛对凝血功能的影响
摘要
目的观察酮咯酸氨丁三醇(KT)复合舒芬太尼用于剖宫产术后静脉自控镇痛(PCIA)的镇痛效果及对患者凝血功能的影响。方法选择蛛网膜下腔阻滞麻醉下行择期剖宫产者60例,将其随机分为实验组和对照组各30例。实验组术后镇痛用KT 3 mg/kg复合舒芬太尼1μg/kg,对照组用舒芬太尼1μg/kg。观察术后6、12、24、48 h视觉模拟评分法(VAS)评分,于术前、复苏后及术后4、8、24 h对患者进行痛阈值测定,依据术后疼痛程度评测患者满意度,分别于麻醉前(T_1)、术后1 d(T_2)、术后2 d(T_3)进行血栓弹力图(TEG)分析,并观察术后不良反应发生情况。结果实验组术后6、12、24 h VAS评分低于对照组,实验组复苏后及术后4、8、24 h痛阀值高于对照组(P均<0.05)。实验组、对照组镇痛满意度分别为83.3%(25/30)、63.3%(19/30),两组比较P<0.05。与对照组T_2、T_3时比较,实验组TEG参数R、K值增大,α、MA值降低(P均<0.05)。实验组术后不良反应发生率低于对照组(P<0.05)。结论 KT复合舒芬太尼用于剖宫产术后镇痛效果好,可一定程度改善患者高凝状态且不增加出血量,不良反应发生率低。
引文
[1] 刘楠,张熙哲,冯艺.超声引导髂腹下∕髂腹股沟神经阻滞和腹横肌平面阻滞用于剖宫产术后镇痛的效果[J].中华麻醉学杂志,2016,36(9):1098-1101.
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[13] Valitalo PA, Kemppainen H, Kulo A, et al. Body weight, gender and pregnancy affect enantiomer-specific ketorolac pharmacokinetics[J]. Br J Clin Pharmacol, 2017,83(9):1966-1975.
[14] 郭东升.酮咯酸氨丁三醇尼松联合舒芬太尼用于妇科手术术后镇痛的疗效观察[J].临床合理用药杂志,2016,9(17):70-71.
[15] Connelly CR, Van PY, Hart KD, et al. Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial[J]. JAMA Surg, 2016,151(10):162069-162071.
[16] Xiao W, Fu W, Wang T, et al. Prophylactic use of tranexamic acid combined with thrombelastogram guided coagulation management may reduce blood loss and allogeneic transfusion in pediatric hemispherectomy: case series[J]. J Clin Anesth, 2016,33(9):149-155.
[17] Connelly CR, Yonge JD, McCully SP, et al. Assessment of three point-of-care platelet function assays in adult trauma patients[J]. J Surg Res, 2017,212:260-269.
[18] Qu Z, Wang G, Xu C, et al. The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement: A prospective study on 60 patients[J]. Int J Surg, 2016,34:58-63.
[19] 张勇,刘树山.酮咯酸氨丁三醇用于手术后自控静脉镇痛的临床研究[J].齐齐哈尔医学院学报,2009,30(9):1040-1041.
[20] 谢国柱,袁志国.酮咯酸氨丁三醇对舒芬太尼用于老年病人术后镇痛的节俭作用[J].中华麻醉学杂志杂志,2012,32(5):573-575.
[21] Alexander R, El-Moalemh HE, Gan TJ. Comparision of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery[J]. J Clin Anesth, 2002,14(3):187-192.
[22] Munro HM, Walton SR, Maiviya S, et al. Low-dose ketorolac improves analgesia and reduce morphine requirement following posterior spinal fusion in adolescents[J]. Can J Anaesth, 2002,49(5):461-466.
[23] Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steoidal anti-infalmmatory drugs:network meta-analysis[J]. BMJ, 2011,342:c7086.
[2] 石巍.米索前列醇与卡前列素氨丁三醇预防剖宫产产后出血的效果比较[J].安徽医药,2017,21(2):311-314.
[3] Abrams GD, Chang W, Dragoo JL. In Vitro Chondrotoxicity of Nonsteroidal Anti-inflammatory Drugs and Opioid Medications[J]. Am J Sports Med, 2017,45(14):3345-3350.
[4] Cussa J, Juarez JM, Gomez CMB, et al. Nanostructured SBA-15 host applied in ketorolac tromethamine release system[J]. J Mater Sci Mater Med, 2017,28(8):113.
[5] Mallandrich M, Fernandez-Campos F, Clares B, et al. Developing Transdermal Applications of Ketorolac Tromethamine Entrapped in Stimuli Sensitive Block Copolymer Hydrogels[J]. Pharm Res, 2017,34(8):1728-1740.
[6] 董林剑,李元海.血栓弹力图的临床应用及发展[J].安徽医药,2015,33(5):817-820.
[7] Schott NJ, Emery SP, Garbee C, et al. Thromboelastography in term neonates.[J] J Matern Fetal Neonatal Med, 2018,31(19):2599-2604.
[8] 王楠,董铁立,付红光.舒芬太尼复合纳布啡用于剖宫产术后自控静脉镇痛的效果[J]. 临床麻醉学杂志,2018,34(5):449-451.
[9] 张中军,刘占立,夏利刚,等.术后疼痛应激对血小板活化及血凝状态的影响[J].深圳中西医结合杂志,2007,17(5):302-305.
[10] 邓应峰,蒋洁珊,刘振华.低剂量吗啡和布托啡诺联合罗哌卡因用于剖宫产手术后镇痛临床观察[J].当代医学,2012,18(12):95-96.
[11] 李条珍,李进进.电针在剖宫产手术后镇痛的临床研究[J].上海针灸杂志,2017,36(8):951-955.
[12] MA Fathalla Z, Vangala A, Longman M, et al. Poloxamer-based thermoresponsive ketorolac tromethamine in situ gel preparations: Design, characterisation, toxicity and transcorneal permeation studies[J]. Eur J Pharm Biopharm, 2017,114:119-134.
[13] Valitalo PA, Kemppainen H, Kulo A, et al. Body weight, gender and pregnancy affect enantiomer-specific ketorolac pharmacokinetics[J]. Br J Clin Pharmacol, 2017,83(9):1966-1975.
[14] 郭东升.酮咯酸氨丁三醇尼松联合舒芬太尼用于妇科手术术后镇痛的疗效观察[J].临床合理用药杂志,2016,9(17):70-71.
[15] Connelly CR, Van PY, Hart KD, et al. Thrombelastography-Based Dosing of Enoxaparin for Thromboprophylaxis in Trauma and Surgical Patients: A Randomized Clinical Trial[J]. JAMA Surg, 2016,151(10):162069-162071.
[16] Xiao W, Fu W, Wang T, et al. Prophylactic use of tranexamic acid combined with thrombelastogram guided coagulation management may reduce blood loss and allogeneic transfusion in pediatric hemispherectomy: case series[J]. J Clin Anesth, 2016,33(9):149-155.
[17] Connelly CR, Yonge JD, McCully SP, et al. Assessment of three point-of-care platelet function assays in adult trauma patients[J]. J Surg Res, 2017,212:260-269.
[18] Qu Z, Wang G, Xu C, et al. The effects of platelet apheresis on blood saving and coagulation in bilateral total hip replacement: A prospective study on 60 patients[J]. Int J Surg, 2016,34:58-63.
[19] 张勇,刘树山.酮咯酸氨丁三醇用于手术后自控静脉镇痛的临床研究[J].齐齐哈尔医学院学报,2009,30(9):1040-1041.
[20] 谢国柱,袁志国.酮咯酸氨丁三醇对舒芬太尼用于老年病人术后镇痛的节俭作用[J].中华麻醉学杂志杂志,2012,32(5):573-575.
[21] Alexander R, El-Moalemh HE, Gan TJ. Comparision of the morphine-sparing effects of diclofenac sodium and ketorolac tromethamine after major orthopedic surgery[J]. J Clin Anesth, 2002,14(3):187-192.
[22] Munro HM, Walton SR, Maiviya S, et al. Low-dose ketorolac improves analgesia and reduce morphine requirement following posterior spinal fusion in adolescents[J]. Can J Anaesth, 2002,49(5):461-466.
[23] Trelle S, Reichenbach S, Wandel S, et al. Cardiovascular safety of non-steoidal anti-infalmmatory drugs:network meta-analysis[J]. BMJ, 2011,342:c7086.