不同剂量羟考酮硬膜外注射预防剖宫产牵拉反应的安全性和有效性分析

doi:10.16352/j.issn.1001-6325.2025.02.0216

基础医学与临床 ›› 2025, Vol. 45 ›› Issue (2): 216-221.doi: 10.16352/j.issn.1001-6325.2025.02.0216

不同剂量羟考酮硬膜外注射预防剖宫产牵拉反应的安全性和有效性分析

韩顺宇¹, 杨薇², 曾涛¹, 谢玉梅¹, 陈丹丹¹, 刘永峰^1*

1.四川省人民医院邛崃医院/邛崃市医疗中心医院麻醉科,四川成都 611530;
2.四川省医学科学院四川省人民医院胸外科,四川成都 610000

收稿日期:2024-07-11 修回日期:2024-10-07 出版日期:2025-02-05 发布日期:2025-01-17
通讯作者: ^*282348057@qq.com
基金资助:
白求恩公益基金会恩泽疼痛管理医学研究项目(ezmr2023-051)

Safety and efficacy analysis of different doses of epidural oxycodone injection for prevention of traction reactions in cesarean sections

HAN Shunyu¹, YANG Wei², ZENG Tao¹, XIE Yumei¹, CHEN Dandan¹, LIU Yongfeng^1*

1. Department of Anesthesiology,Sichuan Provincial People's Hospital Qionglai Hospital, Qionglai Medical Center Hospital,Chengdu 611530;
2. Department of Thoracic Surgery, Sichuan Academy of Medical Sciences-Sichuan Provincial People's Hospital, Chengdu 610000, China

Received:2024-07-11 Revised:2024-10-07 Online:2025-02-05 Published:2025-01-17
Contact: ^*282348057@qq.com

摘要/Abstract

摘要： 目的本研究旨在通过分析不同剂量羟考酮硬膜外注射预防剖宫产术中牵拉反应的安全性和有效性,以明确羟考酮硬膜外注射预防剖宫产牵拉反应的最佳剂量。方法选取 2023年10月至2024年5月期间本院收治欲行剖宫产分娩的产妇119例,随机分为A、B、C、D组,四组产妇均在胎儿娩出断脐后硬膜外注射给药,A、B、C组分别给予羟考酮3 mg、5 mg、7 mg,D组注射等量0.9%氯化钠溶液。比较四组产妇给药前5 min(T0)、给药后5 min(T1)、给药后 10 min(T2)和给药后20 min(T3)的平均动脉压(MAP)、脉搏(P)、呼吸(RR)、脉搏血氧饱和度 (SpO₂)、术中牵拉反应分级、麻醉持续时间、术后48 h内患者自控静脉镇痛(PCIA)按压次数及术后24 h内不良反应。结果四组患者术中T0、T1、T2、T3的生命体征比较,差异无统计学意义,A、B、C组术中牵拉反应发生率分别为20%、17.2%、3.3%显著低于D组53.3%(P＜0.05),且C组牵拉反应发生率显著低于A组(P＜0.05)。A、B、C组麻醉持续时间显著长于D组(P＜0.05),A组和C组PCIA按压次数显著低于D组(P＜0.05),但C组不良反应总体发生率30%显著高于A组(0)和D组(6.7%)(P＜0.05)。结论 3 mg、5 mg、7 mg羟考酮硬膜外注射均可明显的减少剖宫产术中牵拉反应,对术中生命体征影响小,延长麻醉持续时间。其中,硬膜外注射7 mg羟考酮预防术中牵拉反应的效果最好,还可以减少术后PCIA的按压次数,但术后不良反应发生率较高,需要术后密切监护。

关键词: 羟考酮, 剖宫产, 牵拉反应, 内脏痛, 椎管内麻醉

Abstract: Objective To evaluate the safety and effectiveness of different doses of epidural oxycodone injection for traction reaction during cesarean sections to determine the optimal dose. Methods Totally 119 cases of parturients who underwent cesarean sections from October 2023 to May 2024 were selected and randomly divided into groups A, B, C and D. All four groups of lying-in women received epidural injection after the umbilical cord was cut. Groups A,B and C were given oxycodone 3 mg, 5 mg and 7 mg respectively, and group D was given an equal amount of normal saline.The primary outcomes were documentation of maternal vital signs and traction reaction during the surgery.Secondary outcomes included patient-controlled intravenous analgesia(PCIA) times within 48 hours and documentation of any postoperative adverse events within 24 hours. Results The comparison of intra-operative vital signs among the four groups of patients revealed no statistically significant differences. In groups A, B and C the incidence of traction reactions was significantly lower at 20%, 17.2% and 3.3%, respectively, compared to group D at 53.3%, showing statistically significant differences(P＜0.05). Additionally, the incidence of traction reaction in group C was significantly lower than in group A(P＜0.05).Groups A, B and C produced significantly better results than group D in terms of the duration of anesthesia. PCIA presses were substantially less in groups A and C than in group D(P＜0.05), and group C had a significantly higher total incidence of adverse events than group A and group D(P＜0.05). Conclusions Epidural injection of 3 mg, 5 mg and 7 mg oxycodone has been proved to significantly reduce traction reaction during cesarean sections while minimally impacting intraoperative vital signs. This intervention has the potential to extend the duration of anesthesia, decrease the frequency of PCIA presses. Among these, 7 mg is the most effective but has the highest incidence of adverse effects, requiring carefully post-operative monitoring.

Key words: oxycodone, cesarean section, traction reaction, visceral pain, neuraxial anesthesia

中图分类号:

R614

韩顺宇, 杨薇, 曾涛, 谢玉梅, 陈丹丹, 刘永峰. 不同剂量羟考酮硬膜外注射预防剖宫产牵拉反应的安全性和有效性分析[J]. 基础医学与临床, 2025, 45(2): 216-221.

HAN Shunyu, YANG Wei, ZENG Tao, XIE Yumei, CHEN Dandan, LIU Yongfeng. Safety and efficacy analysis of different doses of epidural oxycodone injection for prevention of traction reactions in cesarean sections[J]. Basic & Clinical Medicine, 2025, 45(2): 216-221.

参考文献 15

[1]	Lumbiganon P, Laopaiboon M, Gülmezoglu AM, et al. Method of delivery and pregnancy outcomes in Asia: the WHO global survey on maternal and perinatal health 2007-08[J]. Lancet, 2010,375:490-499.
[2]	Betran AP, Ye J, Moller AB, et al. Trends and projec-tions of caesarean section rates: global and regional estimates[J]. BMJ Glob Health, 2021,6:e005671.doi:10.1136/bmjgh-2021-005671.
[3]	Mhyre JM, Sultan P. General anesthesia for cesarean delivery: occasionally essential but best avoided[J]. Anesthesiology, 2019,130:864-866.
[4]	Liu M, Wang B, Prudence B, et al. Effect of different doses of epidural dexmedetomidine on reducing visceral traction reaction for cesarean section: a double-blind randomized controlled trial[J]. J Anesth, 2023,37:371-378.
[5]	雷敏,王力甚.剖宫产术中牵拉反应预防与治疗的研究进展[J].临床医学研究与实践,2021,6:193-195.
[6]	McCombe K, Bogod DG. Learning from the law. a review of 21 years of litigation for pain during caesarean section[J]. Anaesthesia,2018,73:223-230.
[7]	Landau R, Janvier AS. Are we finally tackling the issue of pain during cesarean section?[J]. Anaesth Crit Care Pain Med, 2021,40:100938.doi:10.1016/j.accpm.2021.100938.
[8]	Bollag L, Lim G, Sultan P, et al. Society for obstetric anesthesia and perinatology: consensus statement and recommendations for enhanced recovery after cesarean[J]. Anesth Analg, 2021,132:1362-1377.
[9]	Watson SE, Richardson AL, Lucas DN. Neuraxial and general anaesthesia for caesarean section[J]. Best Pract Res Clin Anaesthesiol, 2022,36:53-68.
[10]	Hong JY, Jee YS, Jeong HJ,et al. Effects of epidural fentanyl on speed and quality of block for emergency cesarean section in extending continuous epidural labor analgesia using ropivacaine and fentanyl[J]. J Korean Med Sci, 2010,25:287-292.
[11]	Rivière PJ. Peripheral kappa-opioid agonists for visceral pain[J]. Br J Pharmacol, 2004,141:1331-1334.
[12]	An Y, Zhao L, Wang T, et al. Preemptive oxycodone is superior to equal dose of sufentanil to reduce visceral pain and inflammatory markers after surgery: a randomized controlled trail[J]. BMC Anesthesiol, 2019,19:96.doi.org/10.1186/s12871-019-0775-x.
[13]	Arendt-Nielsen L, Olesen AE, Staahl C, et al. Analgesic efficacy of peripheral kappa-opioid receptor agonist CR665 compared to oxycodone in a multi-modal, multi-tissue experimental human pain model: selective effect on visceral pain[J]. Anesthesiology, 2009,111:616-624.
[14]	Kopruszinski CM, Watanabe M, Martinez AL, et al. Kappa opioid receptor agonists produce sexually dimorphic and prolactin-dependent hyperalgesic priming[J]. Pain, 2023,164:e263-e273.
[15]	Seaton S, Reeves M, McLean S. Oxycodone as a component of multimodal analgesia for lactating mothers after caesarean section: relationships between maternal plasma, breast milk and neonatal plasma levels[J]. Aust N Z J Obstet Gynaecol,2007,47:181-185.

编辑推荐 0

Metrics

阅读次数

全文

HTML			PDF

最新录用	在线预览	正式出版	最新录用	在线预览	正式出版
0	0	0	0	0	8

	来源	本网站

	次数	8
	比例	100%

摘要

最新录用	在线预览	正式出版

0	0	45

	来源	本网站

	次数	45
	比例	100%

不同剂量羟考酮硬膜外注射预防剖宫产牵拉反应的安全性和有效性分析

Safety and efficacy analysis of different doses of epidural oxycodone injection for prevention of traction reactions in cesarean sections

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献 15

相关文章 5

编辑推荐 0

Metrics

本文评价

[1]	宋佳, 赵峰, 张婷, 徐静, 孙静莉, 陈震宇. 人羊膜间充质干细胞对大鼠子宫瘢痕的修复作用[J]. 基础医学与临床, 2024, 44(7): 1002-1007.
[2]	方婧涵, 冯颖辰, 韩如泉. 分娩镇痛转剖宫产手术不同麻醉方式对产妇及胎儿围术期的影响[J]. 基础医学与临床, 2024, 44(11): 1573-1577.
[3]	袁保红, 刘小男. 意识指数(IoC1)联合伤害敏感指数(IoC2)监测在全麻剖宫产中的应用效果[J]. 基础医学与临床, 2021, 41(9): 1329-1332.
[4]	崔丽, 于壮. 胃复安预防羟考酮诱导的恶心呕吐的前瞻性观察[J]. 基础医学与临床, 2020, 40(9): 1201-1205.
[5]	徐嘉莹张秀华刘俊涛黄宇光. 静脉右美托咪啶在剖宫产术中对腰麻布比卡因阻滞效果的影响[J]. 基础医学与临床, 2016, 36(6): 826-829.