摘要
目的观察艾司氯胺酮复合羟考酮静脉自控镇痛对剖宫产术后产妇炎性反应及产后状态的影响。方法选取腰硬联合麻醉下行剖宫产产妇80例,采用随机数字表法分为K组和C组,每组各40例。K组术后予艾司氯胺酮0.5 mg·kg^(-1)+羟考酮50mg+托烷司琼10 mg+生理盐水至100 mL;C组术后予羟考酮50 mg+托烷司琼10 mg+生理盐水至100 mL。背景输注剂量1 mL·h^(-1),自控给药量为2 mL,锁定时间为20 min,持续镇痛48 h。记录术后4 h、8 h、12 h、24 h、48 h的视觉模拟疼痛法(VAS)评分、镇痛泵按压次数和镇痛药使用剂量。测定入手术室后麻醉前及术后24 h、48 h白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、白细胞介素-10(IL-10)以及肿瘤坏死因子-α(TNF-α)的水平。观察2组术后恢复情况以及不良事件发生情况。结果在术后24 h、48 h,K组术后疼痛VAS评分均低于C组,差异有统计学意义(P<0.05)。K组镇痛泵按压次数和镇痛药使用剂量少于C组,差异有统计学意义(P<0.05)。术后24 h、48 h,2组IL-1β和IL-6、IL-10以及TNF-α水平均高于同组入手术室后麻醉前,K组IL-1β、IL-6、TNF-α水平低于C组,而IL-10水平高于C组,差异有统计学意义(P<0.05)。K组术后恢复时间短于C组,差异有统计学意义(P<0.05)。2组患者均未出现嗜睡和幻觉的不良事件,在恶心呕吐和头晕方面2组发生率相当,差异无统计学意义(P>0.05)。结论艾司氯胺酮复合羟考酮行静脉自控镇痛,可减轻剖宫产术后的炎症反应,有利于产妇产后状态的快速康复。
AIM To observe the effect of esketamine combined with oxycodone for patient-controlled intravenous analgesia on the inflammatory response and postpartum state after cesarean section.METHODS A total of 80 puerperae undergoing cesarean section under combined spinal-epidural anesthesia were selected and randomly divided into esketamine combined oxycodone group(group K)and oxycodone group(group C),with 40 cases in each group.Group K was given esketamine 0.5 mg·kg^(-1)+oxycodone 50 mg+tropisetron 10 mg+normal saline 100 mL after operation.Group C was given oxycodone 50 mg+tropisetron 10 mg+normal saline 100 mL after surgery.The background infusion dose was 1 mL·h^(-1),the self-controlled administration volume was 2 mL,and the locking time was 20 min,and the analgesia lasted for 48 h.The visual analogue scale(VAS)score,the number of analgesic pump presses and the dosage of analgesics used were recorded at 4 h,8 h,12 h,24 h,and 48 h after operation.The levels of interleukin-1β(IL-1β),interleukin-6(IL-6),interleukin-10(IL-10)and tumor necrosis factor-α(TNF-α)were measured before anesthesia and at 24 h and 48 h after surgery.Meanwhile,the postoperative recovery and adverse reactions of the 2 groups were observed.RESULTS At 24 h and 48 h after surgery,the postoperative VAS scores in group K were lower than that in group C,and the difference was statistically significant(P<0.05).The number of analgesic pump compression and dosage of analgesic drugs used in group K were lower than those in group C,and the difference was statistically significant(P<0.05).At 24 h and 48 h after surgery,the levels of IL-1β,IL-6,IL-10 and TNF-αin both groups were higher than those before anesthesia in the same group,and the levels of IL-1β,IL-6 and TNF-αin group K were lower than those in group C,while the level of IL-10 was higher than that in group C,and the difference was statistically significant(P<0.05).The postoperative recovery time in group K was shorter than that in group C,and the difference was statistically significant(P<0.05).No adverse events such as drowsiness and hallucinations occurred in 2 groups,and the incidence of nausea,vomiting and dizziness was similar in both groups,and the difference was not statistically significant(P>0.05).CONCLUSION Esketamine combined with oxycodone for patient-controlled intravenous analgesia can reduce postoperative inflammatory response after cesarean section and facilitate rapid recovery of postpartum status.
作者
廖俊锋
唐智豪
彭文勇
翁林惠
LIAO Junfeng;TANG Zhihao;PENG Wenyong;WENG Linhui(Department of Anesthesiology,Jinhua Hospital,Medical College of Zhejiang University,Jinhua 321000,China)
出处
《中国临床药学杂志》
CAS
2023年第9期679-683,共5页
Chinese Journal of Clinical Pharmacy
关键词
艾司氯胺酮
剖宫产术
术后镇痛
炎性细胞因子
产后状态
esketamine
cesarean section
postoperative analgesia
inflammatory cytokine
postpartum status
