摘要
目的:基于右美托咪定探究静脉内与周围神经阻滞对顺转剖产妇镇痛效果及产后凝血和应激反应的影响。方法:100名试行阴道顺产中转剖宫产产妇根据麻醉方案不同分为研究组(腹横肌周围神经阻滞,n=56)及对照组(静脉麻醉,n=44)。检测两组产妇术前、手术结束时、术后24 h(空腹)凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、纤维蛋白原(FIB)、血清皮质醇(COR)、肾上腺素(E)、去甲肾上腺素(NE)水平;记录产妇术后4、12、24 h出血量,采用视觉疼痛模拟评分表(VAS)测量产妇术后疼痛程度,术后各时段产妇自控麻醉镇痛泵按压次数及24 h累计麻醉剂的用量及不良反应发生情况。结果:研究组手术结束时及术后2 h血清PT、APTT、TT水平均高于术前及对照组,血清FIB、COR、E、NE水平均高于术前,但低于对照组(P<0.05);研究组术后4、12、24 h出血量、VAS评分、静脉镇痛自控泵按压次数均低于对照组,术后舒芬太尼及地佐辛24 h累计用量均低于对照组(P<0.05);两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:右美托咪定在周围神经阻滞的顺转剖应用相较于静脉麻醉中表现更佳,通过降低术后疼痛程度、出血量,延长PT、APTT时间、降低FIB水平,改善产妇产后高凝高应激状态,并可减少术后麻醉药的使用剂量。
Objective:To investigate the effects of dexmedetomidine intravenous and peripheral nerve block on analgesia,postpartum coagulation and stress response in cesarean delivery women.Methods:A total of 100 parturients undergoing vaginal delivery and cesarean section were selected as the research objects,and they were divided into the study group(n=56,abdominal transverse nerve block)and the control group(n=44,intravenous anesthesia)according to different anesthesia schemes.The prothrombin time(PT),activated partial thromboplastin time(APTT),thrombin time(TT),fibrinogen(FIB),serum fibrinogen(FIB)and serum Cortisol(COR),epinephrine(E),norepinephrine(NE)were measured before operation,at the end of operation and 24 h after operation.The blood loss at 4,12,and 24 h after the operation was recorded,the pain degree of the puerpera was measured by visual pain simulation scale(VAS),maternal self-controlled anesthesia and analgesia pump pressing times and 24 h cumulative anesthetic dosage in each period,and the occurrence of adverse reactions were recorded.Results:Serum levels of PT,APTT and TT at the end of operation and 2 h after operation in the study group were higher than those before operation and the control group(P<0.05),the serum FIB,COR,E and NE levels were higher than those before operation,but lower than those in the control group(P<0.05).The blood loss,VAS score,and the number of times of automatic control pump for intravenous analgesia in the study group after 4,12,and 24 h after operation were lower than those in control group(P<0.05),and the cumulative dosage of sufentanil and dezocine at 24 h after operation was lower than that of the control group(P<0.05),but there was no statistical difference in adverse reactions between the two groups(P>0.05).Conclusion:Compared with intravenous,dexmedetomidine has better performance in the anterotomy application of peripheral nerve block,by reducing postoperative pain,reducing blood loss,prolonging PT,APTT time,reducing FIB level,improve the state of postpartum hypercoagulability and stress and reduce the dosage of postoperative anesthetics.
作者
缪凡
刘忠
张承民
赵鸿雁
刘娟
路峰
苏丹妮
MIAO Fan;LIU Zhong;ZHANG Cheng-min;ZHAO Hong-yan;LIU Juan;LU Feng;SU Dan-ni(Department of Anesthesiology,Chengde Central Hospital,Chengde 067000;Department of Obstetrics,Chengde Central Hospital,Chengde 067000;Department of Protection,Chengde Central Hospital,Chengde 067000;Department of Laboratory,Affiliated Hospital of Chengde Medical College,Chengde 067020;Operating Room,Chengde Central Hospital,Chengde 067000,Hebei,China)
出处
《川北医学院学报》
CAS
2022年第9期1179-1183,共5页
Journal of North Sichuan Medical College
基金
河北省承德市科技计划项目(201903A006)。
关键词
顺产转剖宫产
右美托咪定
静脉麻醉
周围神经阻滞
凝血
应激反应
Vaginal delivery to cesarean delivery
Dexmedetomidine
Intravenous anesthesia
Peripheral nerve block
Coagulation
Stress response
