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目的分析持续硬膜外镇痛对重度子癫前期患者剖宫产术后血儿茶酚胺水平的影响,为母儿健康安全镇痛方案的选择提供参考。方法选择2015年2月-2016年2月在长春市妇产医院行剖宫产的136例重度子痫前期患者作为研究对象,按照就诊顺序编号,采用随机数字表法将患者分为对照组和观察组,每组68例。对照组患者术后未实施持续硬膜外镇痛,观察组患者术后采用持续硬膜外镇痛48 h,比较两组患者手术结束即刻、术后12、24及48 h血浆儿茶酚胺水平、肾上腺素水平及动脉血压,比较两组患者术后12、24及48 h疼痛评分差异,比较两组患者术后48内子痫发生率。结果两组患者年龄、孕周、产次、体质量、体质量指数、入组前平均动脉收缩压、血浆儿茶酚胺及肾上腺素水平比较差异均无统计学意义(均P>0.05)。两组患者手术结束即刻血浆儿茶酚胺水平、肾上腺素水平及动脉收缩压比较差异均无统计学意义(均P>0.05),观察组患者术后12、24及48 h血浆儿茶酚胺和肾上腺素水平明显低于对照组,差异有统计学意义(P<0.05),两组患者平均动脉收缩压比较差异无统计学意义(P>0.05)。术后12、24及48 h观察组患者疼痛评分明显低于对照组,差异有统计学意义(P<0.05),术后48 h内,观察组1例子痫,对照组有3例患者出现子痫,对照组术后子痫发生率明显高于观察组,差异有统计学意义(P<0.05)。结论重度子痫前期患者剖宫产术后实施持续硬膜外镇痛,可有效降低患者血浆儿茶酚胺、肾上腺素水平及疼痛程度,降低剖宫产术对患者产生的生理刺激,降低了术后子痫的发生率,对重度子痫前期剖宫产手术患者具有较高的临床价值。
Objective To analyze the effect of continuous epidural analgesia on blood catecholamine levels in patients with severe preeclampsia after cesarean section, and to provide references for the selection of the mother-child health and safety analgesia program. Methods From February 2015 to February 2016, 136 patients with severe preeclampsia who underwent cesarean section in Changchun Maternity Hospital were enrolled. Patients were divided into control group and random number table according to the order of treatment. Observation group, 68 cases in each group. The patients in the control group were treated with continuous epidural analgesia after operation. The patients in the observation group were treated with continuous epidural analgesia for 48 hours after surgery. The levels of plasma catecholamine, the adrenal gland at 12, 24 and 48 h after surgery were compared between the two groups. The levels of blood pressure and arterial blood pressure were compared between the two groups at 12, 24 and 48 h postoperative pain score differences between the two groups were compared 48 post-eclampsia incidence. Results There was no significant difference in age, gestational age, parity, body mass, body mass index, mean arterial pressure before enrollment, plasma catecholamine and adrenaline levels in both groups (all P> 0.05). Plasma catecholamine levels, epinephrine levels and arterial systolic pressure were not significantly different between the two groups at the end of surgery (all P> 0.05). The levels of plasma catecholamines and epinephrine in the observation group at 12, 24 and 48 h after operation were significantly lower In the control group, the difference was statistically significant (P <0.05). There was no significant difference in average arterial systolic pressure between the two groups (P> 0.05). The scores of pain in the observation group at 12, 24 and 48 hours after operation were significantly lower than those in the control group (P <0.05). Within 48 hours after operation, the observation group had 1 case of eclampsia and the control group had 3 cases Epilepsy, the incidence of postoperative eclampsia in the control group was significantly higher than the observation group, the difference was statistically significant (P <0.05). Conclusions Continuous epidural analgesia after cesarean section in patients with severe preeclampsia can effectively reduce the level of plasma catecholamines and epinephrine and the degree of pain in patients with cesarean section and reduce the physiological stimuli produced by cesarean section in patients, The incidence of epilepsy, cesarean section in patients with severe preeclampsia surgery has a high clinical value.