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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

33

期数:

2016年11

页码:

959-962

栏目:

临床研究

出版日期:

2016-11-05

文章信息/Info

Title:

Effect of intraspinal preemptive analgesia of hydromorphone hydrochloride on the analgesia after cesarean section

作者:

牛富国¹; 刘雪红²; 侯增光²; 徐宗月²; 赵　馨¹

(1.张家口市第五医院麻醉科,河北　张家口　075000；2.张家口市妇幼保健院,河北　张家口　075000)

Author(s):

NIU Fu-guo¹; LIU Xue-hong²; HOU Zeng-guang²; XU Zong-yue²; ZHAO Xin¹

（1.Department of Anesthesia,the Fifth Hospital of Zhangjiakou City,Zhangjiakou 075000,Hebei Province,China;2.Maternity and Child Care Center of Zhangjiakou City,Zhangjiakou 075000,Hebei Province,China）

关键词:

新型阿片类药物; 盐酸氢吗啡酮; 椎管内; 超前镇痛; 剖宫产术

Keywords:

new type opioid; hydromorphone hydrochloride; intraspinal; preemptive analgesia; cesarean section

分类号:

R614；R719.8

DOI:

10.7683/xxyxyxb.2016.11.006

文献标志码:

A

摘要:

目的　比较3种麻醉药物椎管内超前镇痛对剖宫产术后镇痛效果的影响。方法　选取2015年5月至2016年5月在张家口市第五医院接受剖宫产且术后接受镇痛的480例产妇为研究对象，依据镇痛方法分为盐酸氢吗啡酮组280例、吗啡组100例及布比卡因组100例。3组产妇均做术前常规准备，L_2~3间隙腰-硬联合麻醉，分别于手术结束15 min前以盐酸氢吗啡酮0.20 mg、吗啡2.00 mg、布比卡因18.75 mg，加入9 g·L^-1氯化钠8 mL硬膜外导管单次注入，术毕拔除硬膜外导管，常规行术后静脉镇痛；于入室时及气管导管拔除后5 min抽取肘静脉血测定血浆多巴胺（DA）、肾上腺素（E）、去甲肾上腺素（NE）水平，术后6、12、24、48 h采用视觉模拟评分(VAS)记录镇痛效果，Ramsay镇静评分记录镇静效果。结果　盐酸氢吗啡酮组产妇术后6、12、24、48 h VAS评分优于吗啡组和布比卡因组(P<0.05)，且吗啡组低于布比卡因组(P<0.05)；3组产妇术后6、12、24、48 h Ramsay评分比较差异无统计学意义(P>0.05)。气管导管拔除后5 min 3组产妇DA、E、NE水平较麻醉前均升高(P<0.05)，且盐酸氢吗啡酮组显著低于吗啡组和布比卡因组(P<0.05)。结论　椎管内盐酸氢吗啡酮单次给药超前镇痛效果较吗啡和布比卡因好，且不影响术后苏醒质量，并能降低应激反应。

Abstract:

Objective　To explore the effect of intraspinal preemptive analgesia of hydromorphone hydrochloride on the analgesia after cesarean section.Methods　A total of 480 puerpera who admitted in the Fifth Hospital of Zhangjiakou City from May 2015 to May 2016 for cesarean section and accepted analgesia were included in this study and were divided into the hydromorphone hydrochloride group (n=280),morphine group(n=100),and bupivacaine group (n=100) according to the different analgesia methods.The puerpera in the three groups were performed with routine preoperative preparations and all patients were given L_2-3 combined spinal epidural anesthesia.The single epidural injection of hydromorphone hydrochloride (0.20 mg),morphine (2.00 mg),and bupivacaine (18.75 mg)+9 g·L^-1 NaCl (8 mL) was performed respectively at 15 min before the end of operation.The epidural catheter was removed after operation and the routine postoperative intravenous analgesia was performed.The elbow venous blood when entering the operation room and 5 min after removing the tracheal catheter was extracted to detect the plasma dopamine(DA),epinephrine(E),and noradrenaline(NE) levels.The visual analogue scales(VAS) was used to record the analgesia effect at 6,12,24,and 48 h after operation and the Ramsay was used to record the sedation effect.Results　The VAS scores of patients at 6,12,24,and 48 h after operation in the hydromorphone hydrochloride group were significantly superior to those in the morphine group and bupivacaine group (P<0.05);moreover,the VAS scores of patients in morphine group were significantly lower than those in the bupivacaine group (P<0.05).There were no statistic difference of the Ramsay scores at 6,12,24,and 48 h after operation among the three groups(P>0.05).The DA,E,and NE levels of patients at 5 min after removing the tracheal catheter in the three groups were significantly elevated compared with before anesthesia (P<0.05);and above indexes in the hydromorphone hydrochloride group were significantly lower than those in the morphine group and bupivacaine group (P<0.05).Conclusion　Intraspinal preemptive analgesia of hydromorphone hydrochloride has a definite analgesia effect,and it doesn′t affect the postoperative recovery quality,and can reduce the stress reaction.

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更新日期/Last Update: 2016-11-05