文章摘要
卫白杨,王 瑗,李正民,牛江涛,许 丽.罗哌卡因联合氢吗啡酮硬膜外自控镇痛在妊娠期糖尿病患者剖宫产术中的应用效果[J].,2021,(14):2683-2686
罗哌卡因联合氢吗啡酮硬膜外自控镇痛在妊娠期糖尿病患者剖宫产术中的应用效果
Effect of Ropivacaine Combined with Hydromorphone on the PCEA in Cesarean Section of Gestational Diabetes Mellitus
投稿时间:2020-11-23  修订日期:2020-12-18
DOI:10.13241/j.cnki.pmb.2021.14.018
中文关键词: 罗哌卡因  氢吗啡酮  硬膜外自控镇痛  妊娠期糖尿病  剖宫产术
英文关键词: Ropivacaine  Hydromorphone  Epidural Analgesia  Gestational Diabetes Mellitus  Cesarean Section
基金项目:陕西省重点研发计划项目 (2017KW-062)
作者单位E-mail
卫白杨 空军军医大学唐都医院麻醉科 陕西 西安 710038 weibaiyang1985@163.com 
王 瑗 空军军医大学唐都医院麻醉科 陕西 西安 710038  
李正民 空军军医大学唐都医院麻醉科 陕西 西安 710038  
牛江涛 空军军医大学唐都医院麻醉科 陕西 西安 710038  
许 丽 汉中市中心医院麻醉科 陕西 汉中 723000  
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中文摘要:
      摘要 目的:研究罗哌卡因联合氢吗啡酮硬膜外自控镇痛在妊娠期糖尿病患者剖宫产术中的应用效果。方法:选择2018年1月~2019年6月我院行剖宫产术的81例妊娠期糖尿病患者,将其随机分为两组。对照组采用常规肌内注射镇痛的方式进行干预,当产妇无法忍受疼痛时肌内注射哌替啶100 mg。观察组在剖宫产术结束后连接自控镇痛泵,使用氢吗啡酮 0.3 mg+0.75 %罗哌卡因20 mL。比较两组干预前后的醛固酮(aldosterone,ALD)、皮质醇(cortisol,Cor)、血管紧张素Ⅱ(Angiotensin-Ⅱ,Ang-Ⅱ)、去甲肾上腺素(noradrenaline,NE)、血管活性肠肽(vasoactive intestinal peptide,VIP)、胃动素(motilin,MTL)、胆囊收缩(cholecystokinin,CCK)和胃泌素(gastrin,GAS)、血清单核细胞趋化因子蛋白(monocyte chemokine protein-1,MCP-1)、白介素-6(interleukin-6,IL-6)、高迁移率族蛋白(high mobility group protein,HMGB-1)水平的变化。结果:干预后,两组的VLD、Cor、Ang-Ⅱ和NE均较治疗前明显升高(P<0.05),且观察组干预后1 d、2 d的VLD、Cor、Ang-Ⅱ和NE明显低于对照组(P<0.05);干预后,两组的VIP和CCK均较治疗前明显升高(P<0.05),MTL和GAS均较治疗前明显降低(P<0.05),且观察组干预后1 d、2 d的VIP和CCK明显低于对照组(P<0.05),MTL和GAS明显高于对照组(P<0.05);干预2 d后,两组的血清MCP-1、IL-6和HMGB-1水平均较治疗前明显降低(P<0.05),且观察组的血清MCP-1、IL-6和HMGB-1水平明显低于对照组(P<0.05)。结论:罗哌卡因联合氢吗啡酮硬膜外自控镇痛能改善妊娠期糖尿病患者剖宫产术后的胃肠功能,抑制全身炎症反应。
英文摘要:
      ABSTRACT Objective: To investigate the effect of ropivacaine combined with hydromorphone on the PCEA in cesarean section of gestational diabetes mellitus. Methods: Eighty-one patients with gestational diabetes who underwent cesarean section in our hospital from January 2018 to June 2019 were selected and divided into two groups randomly. The control group used conventional intramuscular injection for analgesia to intervene. When the maternal could not bear the pain, intramuscular injection of pethidine 100 mg. The observation group was connected to a self-controlled analgesic pump after the end of cesarean section and used hydromorphone 0.3 mg+0.75 % ropivacaine 20 mL. The levels of ALD, Cor, Ang-Ⅱ, NE, VIP, MTL,CCK and GAS, serum levels of MCP-1, IL-6, HMGB-1 were compared before and after the intervention between the two groups. Results: After intervention, the VLD, Cor, Ang-Ⅱ and NE of the two groups were significantly higher than before treatment (P<0.05), and the VLD, Cor, Ang-Ⅱ and NE of the observation group were significantly lower than those of the control group (P<0.05). After intervention, the VIP and CCK of the two groups were significantly higher than before treatment (P<0.05), the MTL and GAS of the two groups were significantly lower than before treatment (P<0.05), the VIP and CCK of the observation group were significantly lower than those of the control group (P<0.05), the MTL and GAS were significantly higher than those of the control group (P<0.05). After 2 days of intervention, the levels of serum MCP-1, IL-6 and HMGB-1 in the two groups were significantly lower than before treatment (P<0.05), and the levels of serum MCP-1, IL-6 and HMGB-1 in the observation group were significantly lower than those in the control group (P<0.05). Conclusion: Ropivacaine combined with hydromorphone could improve gastrointestinal function and inhibit systemic inflammatory response in patients with gestational diabetes mellitus after cesarean section.
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