吗啡与纳布啡对剖宫产产妇术后相关指标的影响比较

发布时间：2019-01-24 13:49

【摘要】：目的:比较吗啡与纳布啡对剖宫产产妇术后相关指标的影响。方法:120例行剖宫产术的产妇随机分为观察组(60例)和对照组(60例)。术后,观察组产妇采用盐酸纳布啡注射液20 mg+0.75%盐酸罗哌卡因注射液20 mL,硬膜外自控镇痛;对照组产妇采用盐酸吗啡注射液8 mg+0.75%盐酸罗哌卡因注射液20 mL,硬膜外自控镇痛。观察并比较两组产妇镇痛开始时(T_0)、镇痛后6 h(T_1)、12 h(T_2)、24 h(T_3)、48 h(T_4)时的视觉模拟疼痛(VAS)评分、收缩压、舒张压、呼吸速率(RR)、血氧饱和度(SpO_2),T_0、T_3、T_4时的白细胞介素6(IL-6)、IL-8、C反应蛋白(CRP)、泌乳素(PRL)水平,镇痛满意率及不良反应发生情况。结果:两组产妇镇痛满意率比较,差异无统计学意义(96.67%vs.98.33%,P0.05)。两组产妇T_0、T_1、T_4时VAS评分比较,差异均无统计学意义(P0.05);T_2-3时,两组产妇VAS评分均显著高于同组T_0、T_1及T_4时,差异均有统计学意义(P0.05);但两组间比较,差异均无统计学意义(P0.05)。两组产妇T_0-2时的收缩压及不同时间点的舒张压、RR、SpO_2比较,差异均无统计学意义(P0.05);两组产妇T_3-4时收缩压均显著高于同组T_0时,差异均有统计学意义(P0.05);但两组间比较差异均无统计学意义(P0.05)。T_0时,两组产妇IL-6、IL-8、CRP、PRL水平比较,差异均无统计学意义(P0.05)。T_3时,两组产妇IL-6、IL-8、CRP水平均显著高于同组T_0时,但观察组显著低于对照组;T_4时,对照组产妇IL-6、IL-8、CRP水平均显著高于同组T_0时,差异均有统计学意义(P0.05),而观察组产妇T_0与T_4时比较,差异均无统计学意义(P0.05)。两组产妇T_3-4时PRL水平均显著高于同组T_0时,随时间延长逐渐升高,且观察组显著高于对照组,差异均有统计学意义(P0.05)。观察组产妇不良反应发生率显著低于对照组,差异有统计学意义(P0.05)。结论:纳布啡用于剖宫产产妇术后的镇痛效果、心血管影响与吗啡相当,但在降低炎性水平、促进泌乳、安全性方面优于吗啡。
[Abstract]:Objective: to compare the effect of morphine and naporphine on postoperative indexes of cesarean section. Methods: 120 cases of cesarean section were randomly divided into observation group (60 cases) and control group (60 cases). After operation, the patients in the observation group were given epidural analgesia with naporphine hydrochloride injection 0.75% ropivacaine hydrochloride injection for 20 mL,. In the control group, morphine hydrochloride injection 8 mg 0.75% ropivacaine hydrochloride injection 20 mL, patient-controlled epidural analgesia was used. The (VAS) scores of visual analogue pain, systolic pressure and diastolic pressure were observed and compared at the beginning of analgesia (T _ 0), 6 h (T _ S _ 1), 12 h (T _ 2), 24 h (T _ 3), 48 h (T _ 4) after analgesia. Respiratory rate (RR), blood oxygen saturation (SpO_2), T _ 0 / T _ (3) / T _ (3) T _ (4) IL-6, IL-8,C reactive protein (CRP), prolactin (PRL), Satisfaction rate of analgesia and occurrence of adverse reactions. Results: there was no significant difference in the rate of analgesia between the two groups (96.67vs.98.33). There was no significant difference in VAS score between the two groups at the time of T _ 0 / T _ 1 / T _ 4 (P0.05). The VAS scores of the two groups were significantly higher than those of the same group at the time of T _ 2-3 (P0.05), but there was no significant difference between the two groups (P0.05). There was no significant difference in systolic blood pressure and diastolic blood pressure (RR,SpO_2) between the two groups at T0-2 (P0.05). Systolic blood pressure (SBP) of the two groups at T3-4 was significantly higher than that of the same group (P0.05). However, there was no significant difference between the two groups (P0.05). There was no significant difference in the level of IL-6,IL-8,CRP,PRL between the two groups (P0.05). At T3, there was no significant difference in IL-6, between the two groups. The level of IL-8,CRP in the observation group was significantly higher than that in the control group at 0, but in the observation group was significantly lower than that in the control group. The levels of IL-6,IL-8,CRP in the control group were significantly higher than those in the same group at T _ 4 (P0.05), while those in the observation group were significantly higher than those in the control group at T _ 4 and T _ 4, respectively. The difference was not statistically significant (P0.05). The levels of PRL in the two groups were significantly higher than those in the same group at T3-4 and gradually increased with the prolongation of time, and the levels of PRL in the observation group were significantly higher than those in the control group (P0.05). The incidence of adverse reactions in the observation group was significantly lower than that in the control group (P0.05). Conclusion: the analgesic effect of naporphine in cesarean section is similar to that of morphine, but it is superior to morphine in reducing inflammatory level and promoting lactation.
【作者单位】：白银市第一人民医院疼痛麻醉科;
【分类号】：R614

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