Effect of dexmedetomidine combined with ropivacaine and fentanyl combined with ropivacaine for transversus abdominis plane block in women with cesarean section
-
摘要:目的
探讨右美托咪定、芬太尼分别联合罗哌卡因对腹横肌平面阻滞（TAPB）剖宫产产妇术后疼痛及血流动力学指标的影响。
方法选取接受剖宫产手术的120例产妇为研究对象，按照入院奇偶顺序将所有产妇分为A组和B组，每组60例。A组给予芬太尼联合罗哌卡因麻醉，B组给予右美托咪定联合罗哌卡因麻醉，2组产妇在超声引导下行双侧TAPB。采用视觉模拟评分法（VAS）以及术后24 h恢复质量量表（QoR-40）评估2组产妇术后疼痛和恢复情况，统计2组产妇心率（HR）、血氧饱和度（SpO2）、泌乳素分泌水平、平均动脉压（MAP）、有效按压次数、新生儿情况及不良反应发生情况。
结果2组产妇术后6、12、24 h的VAS评分高于术后2 h，术后12 h VAS评分高于术后6 h，术后24 h VAS评分均低于术后6、12 h，差异有统计学意义（P < 0.05）；B组产妇术后6、12、24 h的VAS评分均低于A组，差异有统计学意义（P < 0.05）。与术前比较，2组产妇术后8 h的MAP、SpO2均下降，HR升高，但B组术后8 h的HR低于A组，SpO2水平高于A组，差异有统计学意义（P < 0.05）；2组产妇术后12、24、48 h的泌乳素分泌水平高于术后即刻，术后48 h泌乳素水平高于术后12、24 h，且术后24 h泌乳素水平高于术后12 h，差异均有统计学意义（P < 0.05）；B组术后12、24、48 h的泌乳素水平均高于A组，差异有统计学意义（P < 0.05）。B组QoR-40评分高于A组，有效按压次数少于A组，差异有统计学意义（P < 0.05）。B组不良反应发生率为5.00%（3/60），低于A组的16.67%（10/60），差异有统计学意义（P < 0.05）。
结论右美托咪定和芬太尼均具有良好的镇痛效果，右美托咪定联合罗哌卡因改善术后疼痛效果优于芬太尼联合罗哌卡因，且其对心血管系统和血流动力学指标影响更小，有利于产妇早期泌乳，减少机体对麻醉药物的需求量，降低药物不良反应发生率，加速产妇产后早期恢复。
Abstract:ObjectiveTo investigate the effects of dexmedetomidine combined with ropivacaine and fentanyl combined with ropivacaine for transversus abdominis plane block(TAPB) on postoperative pain and hemodynamics in women with cesarean section.
MethodsA total of 120 puerperas who received cesarean section operations were selected as research objects. All women were divided into group A and group B according to the admission parity order, with 60 cases in each group. Group A was given fentanyl combined with ropivacaine for anesthesia, while group B was given dexmedetomidine combined with ropivacaine for anesthesia. The puerperas of two groups given bilateral TAPB under the guidance of ultrasound. Visual Analogue Scale (VAS) and Quality of Recovery Scale (QoR-40) 24 h after operation were used to evaluate postoperative pain and recovery after childbirth, and maternal heart rate (HR), blood oxygen saturation (SpO2), level of prolactin secretion, mean arterial pressure (MAP), the number of effective compression, and incidence of adverse reactions were recorded.
ResultsThe VAS scores of 6, 12 and 24 h after operation were higher than those of 2 h, VAS score 12 h after surgery was higher than 6 h after surgery, and VAS score 24 h after surgery was lower than that of 6 and 12 h after surgery, and the differences were statistically significant (P < 0.05). VAS scores of the group B at 6, 12 and 24 h after operation were lower than those of group A, the differences were statistically significant (P < 0.05). Compared with before operation, MAP and SpO2 decreased and HR increased in both groups at 8 h after operation, but HR of the group B at 8 h after operation was lower than the group A, and SpO2 level was higher than group A, the differences were statistically significant (P < 0.05). The secretion levels of prolactin in two groups at 12, 24 and 48 h after operation were higher than those at conclusion of operation, the prolactin level at 48 h after operation was higher than that at 12 and 24 h after operation, and prolactin level at 24 h after operation was higher than that at 12 h after operation, the differences were statistically significant (P < 0.05). The prolactin levels of the group B at 12, 24 and 48 h after operation were higher than those of the group A (P < 0.05). The QoR-40 score of the group B was higher than that of the group A, and the number of effective compression was less than that of group A(P < 0.05). The incidence of adverse reactions in the group B was 5.00% (3/60), which was lower than 16.67% (10/60) in the group A (P < 0.05).
ConclusionBoth dexmedetomidine and fentanyl have good analgesic effect. However, dexmedetomidine combined with ropivacaine has better effect on postoperative pain than that of fentanyl combined with ropivacaine, and has less influence on cardiovascular system and hemodynamics. Besides, it is beneficial to early lactation of puerperas, can reduce the body's demand for anesthetic drugs, decrease the incidence of adverse reactions induced by drugs, and accelerate the early postpartum recovery of puerperas.
-
-
表 1 2组产妇不同时点VAS评分比较(x±s)
分 组别 术后2 h 术后6 h 术后12 h 术后24 h A组 1.56±0.82 3.03±0.94*△ 3.47±1.12*#△ 2.53±0.94* B组 1.47±0.78 2.47±0.76*▲△ 3.08±0.94*#▲△ 2.21±0.81*▲ 与术后2 h比较, *P < 0.05; 与术后6 h比较, #P < 0.05; 与术后24 h比较, △P < 0.05; 与A组比较, ▲P < 0.05。 
下载: 导出CSV
表 2 2组产妇不同时点血流动力学指标水平比较(n=60)(x±s)
指标 组别 术前 术后8 h 心率/(次/min) A组 76.21±7.52 81.62±8.54# B组 75.87±7.48 78.41±7.77*# 平均动脉压/mmHg A组 101.57±23.62 91.27±18.23# B组 101.27±23.48 89.28±17.91# 血氧饱和度/% A组 96.32±2.37 94.21±2.14# B组 96.41±2.39 95.43±2.36*# 与A组比较, *P < 0.05; 与术前比较, #P < 0.05。
下载: 导出CSV
表 3 2组产妇QoR-40评分、有效按压次数比较(x±s)
组别 QoR-40评分/分 有效按压次数/次 A组(n=60) 172.53±10.62 8.71±2.94 B组(n=60) 179.77±10.94* 7.36±2.61* QoR-40: 恢复质量量表。与A组比较, *P < 0.05。
下载: 导出CSV
表 4 2组产妇术后不同时点泌乳素分泌水平比较(x±s)
ng/mL 组别 术后即刻 术后12 h 术后24 h 术后48 h A组 213.31±13.62 238.73±15.17*△ 278.17±17.26*#△ 326.41±21.64* B组 212.64±13.53 247.62±16.24*▲△ 293.54±18.83*#▲△ 362.71±23.37*▲ 与术后即刻比较, *P < 0.05; 与术后12 h比较, #P < 0.05; 与术后48 h比较, △P < 0.05; 与A组比较, ▲P < 0.05。
下载: 导出CSV
表 5 2组新生儿情况比较(x±s)
分 组别 Apgar评分 神经行为评分 1 min 5 min 术后12 h 术后24 h A组 93.13±6.61 95.10±7.62 37.89±2.13 38.98±2.64 B组 92.64±7.94 96.57±7.42 38.16±2.42 38.72±2.31
下载: 导出CSV
表 6 2组产妇不良反应发生情况比较[n(%)]
组别 n 头晕 恶心、呕吐 皮肤瘙痒 合计 A组 60 4(6.67) 3(5.00) 3(5.00) 10(16.67) B组 60 1(1.67) 1(1.67) 1(1.67) 3(5.00)* 与A组比较, *P < 0.05。
下载: 导出CSV
-
[1] LI H T, LUO S, TRASANDE L, et al. Geographic Variations and Temporal Trends in Cesarean Delivery Rates in China, 2008-2014[J]. Jama, 2017, 317(1): 69-76. doi: 10.1001/jama.2016.18663
[2] NEDELJKOVIC S S, KETT A, VALLEJO M C, et al. Transversus Abdominis Plane Block With Liposomal Bupivacaine for Pain After Cesarean Delivery in a Multicenter, Randomized, Double-Blind, Controlled Trial[J]. Anesth Analg, 2020, 131(6): 1830-1839. doi: 10.1213/ANE.0000000000005075
[3] MALAWAT A, VERMA K, JETHAVA D, et al. Erector spinae plane block and transversus abdominis plane block for postoperative analgesia in cesarean section: A prospective randomized comparative study[J]. J Anaesthesiol Clin Pharmacol, 2020, 36(2): 201-206. doi: 10.4103/joacp.JOACP_116_19
[4] 徐军, 方建塔. 不同浓度罗哌卡因对剖宫产术后镇痛效应及安全性研究[J]. 中国临床药理学杂志, 2019, 35(22): 2830-2832, 2839. https://www.cnki.com.cn/Article/CJFDTOTAL-GLYZ201922015.htm [5] 高建新, 缪丹. 腹横肌平面阻滞联合右美托咪啶对全身麻醉剖宫产产妇麻醉复苏室苏醒质量的影响[J]. 中国医师杂志, 2021, 23(1): 19-23. doi: 10.3760/cma.j.cn431274-20201104-01492 [6] 晏明, 孙剑, 丁松, 等. 罗哌卡因复合纳布啡与罗哌卡因复合芬太尼用于硬膜外分娩镇痛的比较[J]. 国际麻醉学与复苏杂志, 2020, 41(5): 475-478. doi: 10.3760/cma.j.cn321761-20191024-00032 [7] 中华医学会妇产科学分会产科学组. 剖宫产手术的专家共识(2014)[J]. 中华妇产科杂志, 2014, 49(10): 32-39. https://www.cnki.com.cn/Article/CJFDTOTAL-JKGL201503011.htm [8] 蒋珏, 黄燕. 右美托咪定复合罗哌卡因行腹横肌平面阻滞对开腹手术术后疼痛及炎症反应的影响[J]. 现代中西医结合杂志, 2020, 29(11): 1228-1231. doi: 10.3969/j.issn.1008-8849.2020.11.022 [9] 郑海梅, 陈秀梅, 张秀. 罗哌卡因复合右美托咪定腹横肌平面阻滞对剖宫产术后镇痛的效果探讨[J]. 黑龙江医学. 2021, 45(21): 2276-2278. doi: 10.3969/j.issn.1004-5775.2021.21.013 [10] 赵婷, 周红娟, 吴家伟. 罗哌卡因复合芬太尼腹横肌平面阻滞对剖宫产产妇术后疼痛、血流动力学及泌乳功能的影响[J]. 实用临床医药杂志, 2019, 23(1): 81-84. doi: 10.7619/jcmp.201901022 [11] YEAP Y L, WOLFE J W, KROEPFL E, et al. Transversus abdominis plane (TAP) block for laparoscopic live donor nephrectomy: continuous catheter infusion provides no additional analgesic benefit over single-injection ropivacaine[J]. Clin Transplant, 2020, 34(6): e13861.
[12] SINGLA N, GARG K, JAIN R, et al. Analgesic efficacy of dexamethasone versus dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in Caesarean section: a prospective randomised controlled study[J]. Indian J Anaesth, 2021, 65(Suppl 3): S121-S126.
[13] PRASAD G V K, KHANN S, Jaishree S V. Review of adjuvants to local anesthetics in peripheral nerve blocks: Current and future trends[J]. Saudi Journal of Anaesthesia, 2020, 14(1): 77-84. doi: 10.4103/sja.SJA_423_19
[14] BANSA P, SOOD D. Effect of dexmedetomidine as an adjuvant to ropivacaine in ultrasound-guided transversus abdominis plane block for post-operative pain relief in cesarean section[J]. Journal of Obstetric Anaesthesia and Critical Care, 2018, 8(2): 79-83. doi: 10.4103/joacc.JOACC_53_17
[15] 张晓琴, 詹锐, 彭丽君. 右美托咪定作为罗哌卡因佐剂用于腹横肌平面阻滞对剖宫产术后镇痛的影响[J]. 东南国防医药, 2020, 22(6): 627-631. doi: 10.3969/j.issn.1672-271X.2020.06.015 [16] BODUR S, FIDAN U, KINCI M F, et al. Unicornuate uterus with a rudimentary horn diagnosed at scheduled third Cesarean Section[J]. Pak J Med Sci, 2017, 33(3): 779-781.
[17] CHEN Q, LIU X, ZHONG X J, et al. Addition of dexmedetomidine or fentanyl to ropivacaine for transversus abdominis plane block: evaluation of effect on postoperative pain and quality of recovery in gynecological surgery[J]. J Pain Res, 2018, 11: 2897-2903. doi: 10.2147/JPR.S178516
[18] 师涛丽, 董希玮, 何艳辉, 等. 小剂量纳洛酮复合罗哌卡因或舒芬太尼-罗哌卡因对臂丛神经阻滞的影响[J]. 实用医学杂志, 2017, 33(8): 1310-1313. doi: 10.3969/j.issn.1006-5725.2017.08.030 [19] 吴宇薇, 符永强, 宫庆娟. 舒芬太尼联合罗哌卡因对剖宫产产妇的镇痛效果研究[J]. 实用临床医药杂志, 2020, 24(15): 79-82. doi: 10.7619/jcmp.202015022 [20] 梁霜. 舒芬太尼、罗哌卡因联合分娩镇痛的疗效及安全性[J]. 实用临床医药杂志, 2020, 24(2): 68-71. doi: 10.7619/jcmp.202002020 [21] 吴仁丰, 李艳, 李笃竽, 等. 右美托咪定复合罗哌卡因用于剖宫产术后腹横肌平面阻滞镇痛效果研究[J]. 中国煤炭工业医学杂志, 2021, 24(2): 143-147. https://www.cnki.com.cn/Article/CJFDTOTAL-ZMGY202102007.htm -
期刊类型引用(7)
1. 杨莹，关红梅，王舒，刘冰，陈宛丽. 左归补髓生血汤对阴虚毒瘀型急性髓系白血病患者增效减毒的影响. 新中医. 2021(08): 111-114 . 
百度学术
2. 赵方. 全面护理干预对小儿急性淋巴细胞白血病初次化疗的影响. 实用中西医结合临床. 2021(08): 152-153 . 百度学术
3. 林楠，蒋小平，雷若冰. 黄芪注射液结合化疗对儿童急性淋巴细胞白血病疗效的Meta分析. 儿科药学杂志. 2020(06): 7-11 . 百度学术
4. 郭秋菊，徐琛，乔杨华，姜皓晗，李雪森，黄东生. 肿瘤患儿化疗后感染情况分析. 中华医院感染学杂志. 2019(09): 1429-1432 . 百度学术
5. 李彦毕，刘景珍. 痰热清注射液治疗儿童急性淋巴细胞白血病临床观察. 河北中医. 2018(09): 1344-1347 . 百度学术
6. 楼君，汤婉芬，胡燕珍. 肿瘤化疗患者院内感染危险因素分析及对策研究. 医院管理论坛. 2018(10): 59-61 . 百度学术
7. 于蒙，程泽星. 美洲商陆致中国仓鼠肺细胞染色体畸变实验研究. 实用临床医药杂志. 2018(23): 1-5+9 . 本站查看
其他类型引用(1)
计量
- 文章访问数: 176
- HTML全文浏览量: 61
- PDF下载量: 10
- 被引次数: 8
苏公网安备 32100302010246号