剖宫产术应用地佐辛复合芬太尼静脉镇痛对产妇及新生儿影响的观察

目的 探讨地佐辛用于剖宫产术后镇痛对产妇、新生儿的影响.方法 选取2014年2月至2014年8月在淄博市中心医院择期硬膜外麻醉下行剖宫产术的健康产妇300例,采用随机数字表法分为6组,地佐辛硬膜外镇痛组(DE组)、吗啡硬膜外镇痛组(ME组)、芬太尼静脉镇痛组(FI组)、地佐辛静脉镇痛组(DI组)、地佐辛复合芬太尼静脉镇痛组(TI组)、静脉镇痛安慰剂组(C组),每组50例.对比各组产妇镇痛效果、新生儿神经行为(NBNA)等指标.结果 ME组、C组患者收缩压(SBP)在术后12h高于术后2h,差异均有统计学意义(f值分别为3.917、4.510,均P＜0.05);C组术后12h的舒张压(DBP)高于术后2h,差异有统计学意义(t=2.391,P＜0.05).术后12h、24h、48h,DE组、ME组、FI组、DI组、TI组的视觉模拟评分(VAS)评分均低于C组(t值分别为4.112、3.098、4.098、3.317、3.806、3.075、3.028、3.116、3.309、3.412、4.006、3.575、3.762、3.098、2.947,均P＜0.05),ME组、TI组的VAS评分均低于DE组、FI组、DI组(f值分别为2.298、3.022、2.765、2.884、2.098、3.162、2.285、2.367、2.741、3.112、3.029、2.649、3.356、2.298、3.027、2.289、3.118、2.817,均P＜0.05);术后24h、48h,DE组、ME组、FI组、DI组、TI组的泌乳素(PRL)水平均高于C组(t值分别为2.261、2.908、2.752、3.116、3.309、2.861、2.070、2.713、2.398、2.865,均P＜0.05),术后48h,TI组的PRL水平均高于DE组、ME组、FI组、DI组(t值分别为3.309、3.118、3.471、4.029,均P＜0.05);术后12h,ME组新生儿的NBNA评分均低于DE组、FI组、DI组、TI组、C组(t值分别为3.077、2.964、2.851、4.022、3.816,均P＜0.05);TI组的恶心、呕吐、头晕发生率均低于ME组、FI组(x2值分别为5.579、6.117、5.209、5.816、6.092、7.116,均P＜0.05),DE组、ME组、FI组、DI组的恶心发生率高于C组(x2值分别为5.017、4.409、4.728、5.116,均P＜0.05),ME组、FI组的呕吐、头晕、皮肤瘙痒发生率均高于C组(x2值分别为4.417、4.829、3.908、4.276、4.459、3.928,均P＜0.05).结论 地佐辛复合芬太尼静脉镇痛用于剖宫产产后镇痛,具有镇痛效果良好、对新生儿NBNA评分影响小、不良反应发生率低的优点.

Effects of dezocine combining fentanyl intravenous analgesia on puerpera and neonate in cesarean section

Objective To investigate the analgesic effect of dezocine on pregnant women and neonates after cesarean section.Methods Three hundred healthy pregnant women undergoing epidural anesthesia for selective cesarean section in Shandong Zibo City Central Hospital from February to August in 2014 were selected and divided into six groups with random number table method,dezocine epidural analgesia group (DE group),morphine epidural analgesia group (ME group),fentanyl intravenous analgesia group (FI group),dezocine intravenous analgesia group (DI group),dezocine and fentanyl analgesia group (TI group) and intravenous analgesia in placebo group (C group) with 50 cases in each group.Effects of maternal analgesia and neonatal behavioral neurological assessment (NBNA) and other indicators were compared among groups.Results In ME group and C group systolic blood pressure (SBP) 12h after surgery was higher than that of 2h,and the differences were statistically significant (t value was 3.917 and 4.510,respectively,both P ＜ 0.05).In C group diastolic blood pressure (DBP) 12h after surgery was higher than 2h after operation,and the difference was statistically significant (t =2.391,P ＜0.05).After 12h,24h and 48h,DE group,ME group,FI group,DI group and TI group had lower VAS scores compared to those of C group (t value was 4.112,3.098,4.098,3.317,3.806,3.075,3.028,3.116,3.309,3.412,4.006,3.575,3.762,3.098 and 2.947,respectively,all P ＜ 0.05).In ME group and TI group the VAS scores were lower than those in DE group,FI group and DI group (t value was 2.298,3.022,2.765,2.884,2.098,3.162,2.285,2.367,2.741,3.112,3.029,2.649,3.356,2.298,3.027,2.289,3.118 and 2.817,respectively,all P ＜ 0.05).After 24h and 48h,DE group,ME group,FI group,DI group and TI group had higher PRL levels than C group (t value was 2.261,2.908,2.752,3.116,3.309,2.861,2.070,2.713,2.398 and 2.865,respectively,all P ＜ 0.05).After 48h,the PRL level in TI group was higher than that in DE group,ME group,FI group and DI group (t value was 3.309,3.118,3.471 and 4.029,respectively,all P ＜ 0.05).After 12h,neonatal NBNA score in ME group was lower than that in DE group,FI group,DI group,TI group and C group (t value was 3.077,2.964,2.851,4.022 and 3.816,respectively,all P ＜ 0.05).The incidence of nausea,vomiting and dizziness in TI group was lower than that in ME group and FI group (x2 value was 5.579,6.117,5.209,5.816,6.092 and 7.116,respectively,all P ＜ 0.05).In DE group,ME group,FI group and DI group the incidence of nausea was higher than in C group (x2 value was 5.017,4.409,4.728 and 5.116,respectively,all P ＜ 0.05),while the incidence of vomiting,dizziness and itchy skin in ME group and FI group was higher than in C group (x2 value was 4.417,4.829,3.908,4.276,4.459 and 3.928,respectively,all P ＜ 0.05).Conclusion Dezocine and fentanyl for analgesia after cesarean section analgesia has the advantages of good analgesic effect,little influence on neonatal NBNA score and low incidence of adverse reactions.