多模式镇痛应用于单胎横切口剖宫产手术后的镇痛效果评价-现代医学

多模式镇痛应用于单胎横切口剖宫产手术后的镇痛效果评价

单位：江苏省东台市中医院麻醉科, 江苏东台 224200

分类号：R614

出版年·卷·期（页码）：2022·50·第十二期（1536-1541）

摘要：

目的：探讨多模式镇痛(MMA)技术应用于剖宫产手术的镇痛效果。方法：选取我院2018年5月至2020年4月收治的76例单胎横切口剖宫产手术产妇为研究对象，随机分为对照组和观察组，分别给予传统模式镇痛和MMA技术镇痛，分析产妇的镇痛效果和不良反应。结果：对照组和观察组产妇术后3 h时静息痛、运动痛的视觉模拟量表(VAS)评分比较差异无统计学意义(P>0.05)，而术后12、24 h时观察组产妇静息痛、运动痛的VAS评分低于对照组(P<0.05)。观察组产妇的初次哺乳时间和自理能力恢复时间短于对照组，而满意度评分高于对照组(P<0.05)。观察组产妇术后24 h检测的外周血肿瘤坏死因子α(TNF-α)、神经肽Y (NPY)和C反应蛋白(CRP)3项炎症因子水平均低于对照组，差异具有统计学意义(P<0.05)。此外观察组产妇的不良反应发生率低于对照组，差异具有统计学意义(P<0.05)。结论：MMA技术对剖宫产手术产妇的镇痛效果要优于传统模式镇痛。

Objective: To explore the analgesic effect of multimodal analgesia(MMA) technique in transverse incision cesarean section of singleton pregnancy. Methods: Seventy-six patients with selective transverse incision cesarean section of singleton pregnancy were divided into control group and observation group randomly. Control group was given traditional mode analgesia, observation group was given MMA. The analgesic effect and adverse reaction were analyzed. Results: There were significant differences in visual analogue scale(VAS) scores of both resting-pain and exercise-pain between the two groups(P<0.05). The initial lactation time and self-recovery time in observation group were shorter than those in control group, and the satisfaction score was higher than that in control group(P<0.05). The levels of CRP, TNF-α and NPY and the adverse reaction rate in the observation group were lower than those in the control group, and the differences were statistically significant(P<0.05). Conclusion: The MMA technique is safe and effective in cesarean section with transverse incision cesarean section of singleton pregnancy.

参考文献：

[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.
[2] 于瀛, 马腾彪, 戚思华. 剖宫产术后镇痛方式的研究进展[J].医学综述, 2021, 27(1): 126-129.
[3] 董静宇，石翊飒.多模式镇痛应用进展及发展趋势[J].国际麻醉学与复苏杂志，2014，35(2): 178-183.
[4] 王家宾, 马兴建, 李璟,等.多模式镇痛应用于剖宫产手术效果观察[J].人民军医, 2019, 62(6): 548-550.
[5] SCHECK S M, BLACKMORE T, MAHARAJ D, et al. Caesarean section wound infection surveillance: information for action[J].Aust NZJ Obstet Gynaecol, 2017, 3(1): 206-209.
[6] 张明, 谭诗亮, 潘丽娟,等.剖宫产术后慢性疼痛的研究进展[J].解放军护理杂志, 2016, 33(3): 48-51.
[7] 何国平. 产后抑郁症相关性分析[J].中南大学学报医学版, 2017, 32(3): 460-465.
[8] 王合丽. 剖宫产术后疼痛的原因分析和护理对策[J].中外医学研究, 2013, 11(32): 100-101.
[9] 黎金玲.剖宫产术后疼痛护理干预及研究进展[J].当代临床医刊, 2016, 29(3): 2301-2302.
[10] YURASHEVICH M，CARVALHO B，BUTWICK A J，et al.Determinants of women's dissatisfaction with anaesthesia care in labour and delivery[J].Anaesthesia, 2019, 74(9): 1112-1120.
[11] 常建华, 金梅梅, 张文娟,等.地佐辛在剖宫产术后集束化镇痛措施中的作用[J].中国临床研究, 2018, 31(3): 380-383.
[12] 孟晓波.剖宫产术后镇痛对血浆泌乳素的影响[J].徐州医学院学报, 2007, 27(7): 473-474.
[13] SUMIKURA H,NIWA H,SATO M,et al. Rethinking general anesthesia for cesarean section[J].J Anesth, 2016, 30(2): 268-273.
[14] 李兰兰, 冯莺. 剖宫产术后镇痛对产妇泌乳影响的研究进展[J].护理学报, 2014, 21(22): 21-24.
[15] 琚晓敏, 郭金风. 剖宫产与阴道分娩对前次剖宫产再次妊娠产妇的应激及炎性状态分析[J].中国计划生育学杂志, 2017, 25(7): 471-473.
[16] ILHAN G,ATMACA F F V, KAYA A, et al. Risk factors and microbiology of wound infections following cesarean delivery: experience of a single institution[J].J Infect Chemother, 2016, 22(10): 667-670.
[17] 姜思源，张锦.手术应激后低蛋白血症启因及治疗的最新进展[J].中华危重病急救医学，2017, 29(3): 284-288.
[18] MAHOMED K, IBIEBELE I, BUCHANAN J, et al. The Betadine trial-antiseptic wound irrigation prior to skin closure at caesarean section to prevent surgical site infection: a randomised controlled trial[J].Aust NZJ Obstet Gynaecol, 2016, 56(3): 301-306.
[19] 胡万芹, 杜玲, 吴灿,等.剖宫产产妇术后感染相关因素及炎症因子和T淋巴细胞亚群指标的研究[J].中华医院感染学杂志,2018, 6(4): 590-593.
[20] 李明，潘旭.剖宫产产妇术后切口感染者血清炎性应激指标与应激激素和免疫应答的相关性[J].中华实验和临床感染病杂志, 2019, 13(1): 70-75.
[21] MAXIMIANO C, LOPEZ I, MARTIN C, et al. An exploratory, large-scale study of pain and quality of life outcomes in cancer patients with moderate or severe pain, and variables predicting improvement[J].PLoS One, 2018, 13(4):e0193233.

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