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| 奥赛利定静脉自控镇痛联合腹横肌平面阻滞对肥胖产妇剖宫产术后恢复的影响 |
| Effect of oliceridine patient-controlled intravenous analgesia combined with transversus abdominis plane block on postoperative recovery in obese parturients undergoing cesarean section |
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| DOI：10.12089/jca.2025.07.008 |
| 中文关键词: 肥胖 剖宫产 奥赛利定 舒芬太尼 腹横肌平面阻滞 患者自控静脉镇痛 |
| 英文关键词: Obese Cesarean section Oliceridine Sufentanil Transversus abdominis plane block Patient-controlled intravenous analgesia |
| 基金项目:吴阶平医学基金会（320.6750.2024-05-18） |
| 作者 | 单位 | E-mail | | 刘克 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 葛秀玲 | 257000,山东省东营市,胜利油田中心医院医务部 | | | 张帅帅 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 梅莎莎 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 吕凯丽 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 盖志辉 | 257000,山东省东营市,胜利油田中心医院医务部 | | | 王帅 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 王大龙 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 徐伟民 | 257000,山东省东营市,胜利油田中心医院麻醉科 | | | 叶文学 | 257000,山东省东营市,胜利油田中心医院医务部 | yewenxuehaha@163.com |
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| 中文摘要: |
目的：观察和比较奥赛利定与舒芬太尼静脉自控镇痛联合腹横肌平面阻滞（TAPB）对肥胖产妇剖宫产术后恢复的影响。
方法：选择2024年3—12月择期行剖宫产产妇120例，年龄22～34岁，BMI 30.0～35.0 kg/m2，ASA Ⅰ—Ⅲ级。采用随机数字表法将产妇分为两组：奥赛利定组（O组）和舒芬太尼组（S组），每组60例。胎儿娩出后，O组静脉注射奥赛利定1 mg；S组静脉注射舒芬太尼5 μg。手术结束即刻连接静脉镇痛泵，O组给予奥赛利定0.3 mg/kg，S组给予舒芬太尼2 μg/kg，均复合托烷司琼10 mg并用生理盐水稀释至100 ml。手术结束即刻，两组实施相同方案超声引导下TAPB，每侧给予0.375%罗哌卡因20 ml。于术前2 h、术后1、2 d行15项恢复质量（QoR-15）评估。记录术后首次肛门排气时间和术后首次下床活动时间。记录术后2、4、8、12、24、48 h静息和宫缩时VAS疼痛评分、术后48 h内镇痛泵有效按压次数和补救镇痛情况。于术前2 h和术后24、48 h检测血清白细胞介素-6（IL-6）、C反应蛋白（CRP）浓度。采用Likert计分法评估术后舒适度。记录术后48 h内呼吸抑制、恶心呕吐、头晕、腹胀等不良反应的发生情况。
结果：与S组比较，O组术后1 d QoR-15评分、术后舒适度评分明显升高，术后首次肛门排气时间明显缩短，术后2、4、8、12、24 h静息和宫缩时VAS疼痛评分、补救镇痛率、术后24 h血清IL-6、CRP浓度、术后48 h内呼吸抑制和恶心呕吐发生率明显降低，术后48 h内镇痛泵有效按压次数明显减少（P＜0.05）。两组术后2 d QoR-15评分、术后首次下床活动时间、术后48 h静息和宫缩时VAS疼痛评分、术后48 h血清IL-6、CRP浓度差异无统计学意义。
结论：奥赛利定静脉自控镇痛联合TAPB应用于肥胖产妇剖宫产术后镇痛安全有效，与舒芬太尼比较，可明显提高产妇术后早期舒适度，且不增加呼吸抑制、恶心呕吐发生率。 |
| 英文摘要: |
Objective: To observe and compare the effect of oliceridine vs sufentanil patient-controlled intravenous analgesia combined with transversus abdominis plane block (TAPB) on the postoperative recovery in obese parturients undergoing cesarean section.
Methods: A total of 120 parturients scheduled for cesarean section from March to December 2024 were selected, aged 22-34 years, BMI 30.0-35.0 kg/m2, ASA physical status Ⅰ-Ⅲ. The parturients were randomly divided into two groups using random number table method: oliceridine group (group O) and sufentanil group (group S), 60 parturients in each group. After the fetus was delivered, the parturients in group O was intravenously injected with oxelidine 1 mg, and the parturients in group S was intravenously injected with sufentanil 5 μg. Immediately after the operation, an intravenous analgesic pump was connected. Group O was given oxelidine 0.3 mg/kg, and group S was given sufentanil 2 μg/kg. Both groups were combined with tropisetron 10 mg and diluted to 100 ml with normal saline. Immediately after the operation, the same protocol of ultrasound-guided TAPB was implemented in the two groups, with 0.375% ropivacaine 20 ml in each side. The 15-item quality of recovery (QoR-15) assessment was performed 2 hours before the operation, 1 day and 2 days after the operation. The time of the first anal exhaust and first ambulation after the operation were recorded. The VAS pain scores at rest and during uterine contractions 2, 4, 8, 12, 24, and 48 hours after the operation, the effective compression times of the analgesic pump within 48 hours after the operation, and the remedial analgesia conditions were recorded. The concentrations of serum interleukin-6 (IL-6) and C-reactive protein (CRP) were detected 2 hours before the operation, 24 and 48 hours after the operation. The Likert scoring method was used to evaluate the postoperative comfort level. The adverse reactions such as respiratory depression, nausea and vomiting, dizziness, and abdominal distension within 48 hours after the operation were also recorded.
Results: Compared with group S, the QoR-15 score and postoperative comfort score 1 day after surgery in group O were significantly increased, and the time for the first anal exhaust after surgery was significantly shortened (P < 0.05). Compared with group S, the VAS pain scores at rest and during uterine contractions 2, 4, 8, 12, and 24 hours after the operation, the rate of remedial analgesia, the concentrations of serum IL-6 and CRP 24 hours after the operation, and the incidences of respiratory depression and nausea and vomiting within 48 hours after the operation were significantly reduced, and the effective compression times of the analgesic pump within 48 hours after the operation were significantly decreased in group O (P < 0.05). There was no statistically significant difference in the QoR-15 score 2 days after the operation, the time of the first ambulation after the operation, the VAS pain score at rest and during uterine contractions 48 hours after the operation, and the concentrations of serum IL-6 and CRP 48 hours after the operation between the two groups.
Conclusion: Compared with sufentanil, the application of oliceridine patient-controlled intravenous analgesia combined with TAPB is safe and effective for postoperative analgesia in obese parturients undergoing cesarean section, improving early postoperative comfort without increasing the incidence of respiratory depression, nausea and vomiting. |
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