摘要
目的:目前临床上分娩镇痛中转剖宫产的产后镇痛方式仍以静脉镇痛泵为主,但存在镇痛效果不完善的案例。本研究观察硬膜外单次注入盐酸氢吗啡酮复合罗哌卡因对经阴道分娩镇痛中转剖宫产产妇术后的镇痛效果。方法:选取南京医科大学附属妇产医院2023年4月至11月收治的60例硬膜外分娩镇痛下行阴道试产失败而中转剖宫产的产妇为研究对象。根据手术缝皮时采用的硬膜外镇痛药物,将60例产妇随机分为盐酸氢吗啡酮复合罗哌卡因组(H组)和罗哌卡因组(C组),每组30例。2组产妇进入手术室后,麻醉医师均通过硬膜外分娩镇痛导管注入2%利多卡因3 mL,观察5 min无不良反应后,继续注入3%氯普鲁卡因15~20 mL行硬膜外麻醉。手术缝皮时,H组经硬膜外腔注入0.02 mg/mL盐酸氢吗啡酮与0.1%罗哌卡因的混合溶液10 mL,C组经硬膜外腔注入0.1%罗哌卡因10 mL。2组产妇术后均采用静脉自控镇痛泵镇痛。比较2组产妇术后6、12、24 h的疼痛视觉模拟评分法(Visual Analogue Scale,VAS)评分;比较2组产妇手术时间、术中静脉辅助镇痛(给予艾司氯胺酮20~30 mg)比例、术后康复情况(术后首次下床时间、首次下床活动持续时间、术后肛门排气恢复时间)、术后药物相关不良反应(嗜睡、头晕、呕吐、皮肤瘙痒等)情况以及术后24 h睡眠满意度评分。结果:2组产妇一般资料、手术时间、术中静脉辅助镇痛比例比较,差异均无统计学意义(均P>0.05);H组术后首次下床时间、术后肛门排气恢复时间均短于C组,首次下床活动持续时间长于C组,差异均有统计学意义(均P<0.05)。H组产妇术后24 h睡眠满意度评分高于C组,差异有统计学意义(t=3.084,P=0.003);2组产妇术后药物相关不良反应发生率比较,差异无统计学意义(χ^(2)=0.082,P=0.774)。不同时间点比较时,H组VAS评分均低于C组,差异均有统计学意义(均P<0.05);H组内不同时间点VAS评分两两比较,差异均无统计学意义(均P>0.05);C组术后6、24 h的VAS评分均低于术后12 h的VAS评分,差异均有统计学意义(均P<0.05)。结论:硬膜外单次注入盐酸氢吗啡酮复合罗哌卡因可减轻经阴道分娩镇痛中转剖宫产产妇术后疼痛程度,促进产妇术后快速康复,值得临床应用。
Objective:In current clinical practice,patient-controlled intravenous analgesia remains the primary method for postoperative pain relief in parturients undergoing cesarean section following conversion from vaginal delivery with labor analgesia.However,its analgesic effect is not always optimal.This study aims to investigate the efficacy of a single epidural injection of hydromorphone combined with ropivacaine in relieving postoperative pain in such patients.Methods:A total of 60 parturients undergoing cesarean section after failed vaginal delivery with epidural labor analgesia in Women’s Hospital of Nanjing Medical University,between April and November 2023 were included.Based on the epidural analgesic regimen administered at the time of skin closure,they were randomly divided into 2 groups:A hydromorphone plus ropivacaine group(H group)and a ropivacaine-only group(C group),with 30 patients in each group.Upon entering the operating room,both groups received 3 mL of 2%lidocaine via the epidural catheter for test dosing.After 5 minutes without adverse reactions,15 to 20 mL of 3%chloroprocaine was injected to induce epidural anesthesia.At skin closure,the H group received 10 mL of 0.02 mg/mL hydromorphone hydrochloride combined with 0.1%ropivacaine via the epidural space,while the C group received 10 mL of 0.1%ropivacaine alone.Postoperatively,both groups used intravenous patient-controlled analgesia.Pain levels at 6,12,and 24 hours postoperatively were assessed using the Visual Analogue Scale(VAS).Additionally,operative time,intraoperative use of rescue intravenous analgesia(esketamine 20 to 30 mg),postoperative recovery metrics(time to the first ambulation,and time to the first anal exhaust),drug related adverse effects(e.g.somnolence,dizziness,vomiting,itching),and 24-hour sleep satisfaction were compared between the 2 groups.Results:There were no significant differences between the 2 groups in baseline characteristics,operation time,or intraoperative use of esketamine(all P>0.05).The H group had significantly shorter fist ambulation and anal exhaust,and a longer duration of initial ambulation compared to the C group(all P<0.05).Sleep satisfaction at 24 hours postoperatively was significantly higher in the H group(t=3.084,P=0.003).There was no significant difference in the incidence of drug-related adverse events between the 2 groups(χ^(2)=0.082,P=0.774).At all time points,VAS scores were significantly lower in the H group than in the C group(all P<0.05).Within-group comparisons in the H group showed no significant differences in VAS scores between time points(all P>0.05).In the C group,VAS scores at 6 and 24 hours postoperatively were significantly lower than those at 12 hours(both P<0.05).Conclusion:A single epidural injection of hydromorphone hydrochloride combined with ropivacaine significantly reduces postoperative pain and promotes enhanced recovery in parturients undergoing cesarean section following conversion from vaginal delivery analgesia.This method is clinically valuable and warrants broader application.
作者
刘芳芳
王璇
朱运河
LIU Fangfang;WANG Xuan;ZHU Yunhe(Department of Anesthesiology,Women’s Hospital of Nanjing Medical University,Nanjing Maternity and Child Health Care Hospital,Nanjing 210004,China)
出处
《临床与病理杂志》
2025年第3期329-335,共7页
Journal of Clinical and Pathological Research
作者简介
第一作者:刘芳芳,Email:lffchina 2022@126.com,ORCID:0009-0004-0065-2305;通信作者:朱运河,Email:yhzhu 1998@126.com,ORCID:0009-0002-9553-3805。
