| Objective Pain and operative fatigue associated with cesarean section can delay postoperative recovery.Postoperative pain not only affects the prognosis of the mother,restricts her movements,but also affects her breastfeeding to the newborn and prevents mother-to-child communication.If the pain persists,it can be turned into chronic pain,which places a great physical and psychological burden on the patient and his family.There is currently no “gold standard vertebra” for analgesia after cesarean section.This article observes whether dexmedetomidine hydrochloride combined with oxycodone is used for intravenously controlled analgesia for cesarean section postoperative maternal indicators,and explores whether the clinical application of the analgesic program is safe and effective,and whether it can help improve patients.Postoperative recovery.Methods Eighty cases of primiparous women aged 24 to 35 years were selected from June 2019 to December 2019 at the XXX hospital under the combined spinal and epidural anesthesia under uterine cesarean section and underwent intravenous self-controlled analgesia.Grades I to II,weighing 59 to 85 kg;the randomized number table was used to divide the included cases into two groups according to the maternal admission order,the test group(group A)and the control group(group B),with 40 cases in each group.In group A,dexmedetomidine 200 μg + oxycodone hydrochloride 0.8 mg /kg,0.9% sodium chloride injection was diluted to 100 ml intravenous pump analgesia;postoperative analgesia pump in group B only used oxycodone Ketone 0.8mg / kg,the dilution method and total amount are the same as group A.The two groups of self-controlled intravenous analgesia pumps were set as follows: the two groups of self-controlled intravenous analgesia pumps were set as follows: a total of 100 ml,a first dose of 2ml,a continuous background infusion of 2.0ml / h,a single dose of 2ml,and alockout interval of 15 min,The limit is 10 ml / h.Observation indicators: VAS analgesic score and OAA / S modified sedation score at 1h,2h,4h,8h,12 h,24h,and 48 h after surgery;the number of single administrations of the analgesic pump at 48 hours after operation,whether to add remedial drugs,record When and what drugs to use,dosage and frequency of use;record the first lactation time of the postpartum mother;detect prolactin,adrenocorticotropic hormone,and prostaglandin levels 24 hours before surgery,24 hours after surgery,and 48 hours after surgery;record The number of adverse reactions occurred;the FSS fatigue scale and Qo R-40 scale scores were recorded 1 day before surgery,1,3,and 5 days after surgery,respectively.Results The general basic information of patients,age,body mass index(BMI),ASA classification,number of weeks of pregnancy,nutritional status and length of cesarean section,there were no significant differences between the two groups of pregnant women(p> 0.05).In terms of VAS and OAA / S scores,there was no significant difference between the two groups of patients at 48 hours(T 7)after surgery(P> 0.05);but at various time points(T1-T6)within 24 hours from the end of surgery,A Compared with group B,the score was significantly lower,and the difference was statistically significant(P <0.05).In terms of additional medicines,the requirement for self-administration of intravenous analgesia pumps in group B in 48 hours was significantly lower than that in group A(P <0.05),and the consumption of oxycodone hydrochloride in group A was also lower than that in group B(P <0.05);There was no record of use of additional analgesics in the groups.Hormones: 1.Serum prolactin levels:The secretion levels in the two groups were similar 24 hours before surgery and were not statistically significant(P> 0.05),but at 24 and 48 hours after surgery,the serum prolactin concentrations detected in group A were relative to B.The group was significantly higher and statistically significant(P <0.05).2.Adrenocorticotropic hormone and prostaglandin:24 hours before surgery and 48 hours after surgery,the levels of the two hormones were similar in the two groups of patients(P> 0.05),but serum was detected in group A 24 hours after surgery.The concentrations of both hormones were lower than those of group B(P <0.05).In terms of adverse reactions,the number of patients with dizziness,nausea and vomiting in group A was significantly reduced compared with group B(P <0.05),and there were no other adverse reactions requiring clinical intervention in both groups.Postoperative fatigue assessment: When comparing within the group,the levels of the FSS fatigue scale scores of the two groups of maternal patients on the first and third postoperative days were higher than the preoperative assessment.On the 5th day after surgery,the scores of group A patients were similar to those before surgery,and there was no statistical significance(P> 0.05),but the scores of group B were still higher than the basic value(P <0.05).When comparing between groups,the scores of group B on the first and third postoperative days were generally higher than those of group A,and the degree of fatigue was heavier(P <0.05).The scores on the first day and The test results on day 5 were similar(P> 0.05),but on the third day,the scores in group A were significantly higher than those in group B(P <0.05).Conclusion Dexmedetomidine hydrochloride combined with oxycodone for intravenous self-controlled analgesia after cesarean section can achieve the ideal analgesic effect,and greatly reduce the total amount of oxycodone used,and related complications occur Reduced,security can be guaranteed.Adding dexmedetomidine to self-controlled analgesia helps reduce stress,does not affect the release of serum prolactin,and does not cause lactation disorders.The use of the two in PCIA in multimodal analgesia can help reduce postoperative fatigue and improve the quality of recovery without prolonging hospital stay and improving patient satisfaction. |
PDF Full Text Request