不同静脉镇痛方法用于剖宫产术后伤口疼痛和子宫收缩痛的效果

Effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section

目的 评价不同药物静脉自控镇痛用于剖宫产术后伤口疼痛和子宫收缩痛的效果.方法 美国麻醉医师协会（ASA）分级I～Ⅱ级剖宫产产妇400例,根据静脉镇痛药物不同分为四组：舒芬太尼组（S组,96例）,舒芬太尼＋氟比洛芬酯组（SK组,99例）,布托啡诺组（N组,106例）和布托啡诺＋氟比洛芬酯组（NK组,99例）,麻醉方法采用蛛网膜下隙与硬膜外隙联合阻滞麻醉,手术结束时均接受静脉自控镇痛.记录产妇术后静息和动态伤口疼痛、子宫收缩痛数字评价量表（NRS）评分、镇静程度Ramsay评分以及不良反应.结果 400例产妇均完成观察.四组产妇的年龄、体重、孕周和手术时间比较差异无统计学意义（P＞0.05）.四组静息伤口疼痛NRS评分比较差异无统计学意义（P＞0.05）.动态伤口疼痛NRS评分在术后13h时S组明显低于N组[（3.6±1.3）分比（5.4±1.2）分],差异有统计学意义（P＜0.05）.子宫收缩痛NRS评分在术后4h和13h时,N组和SK组均优于S组[（1.3±1.0）、（1.1±0.9）分比（2.5±1.1）分,（1.6±1.0）、（1.4±0.9）分比（2.9±1.1）分],差异有统计学意义（P＜0.05）.N组产妇镇静程度Ramsay评分和头昏发生率显著高于S组,差异有统计学意义（P＜0.05）.四组均未出现镇静过度病例.所有新生儿未发现有反应减弱或其他异常情况.结论 舒芬太尼联合非甾体抗炎药用于剖宫产术后静脉自控镇痛安全而且更有效,可以同时缓解产妇伤口疼痛和子宫收缩痛.

Objective To evaluate the effect of different intravenous analgesia methods on postoperative incisional and uterine contraction pain after cesarean section.Methods Four hundred parturients （ASA Ⅱ-Ⅱ） undergoing cesarean section were randomly allocated into 4 groups,including sufentanil group （group S,96 cases）,sufentanil combined with flurbiprofen axetil group （group SK,99 cases）,butorphanol group （group N,106 cases） and butorphanol combined with llurbiprofen axetil group （group NK,99 cases）.All the parturients received the operation under epidural combined with spinal anesthesia,and received patient-controlled intravenous analgesia （PCIA） after cesarean section.Numerical rating scale （NRS） of postoperative rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale （RSS）,and PCIA-related adverse events were recorded for 24 h after operation.Results All the parturients were finished this study.The age,body weight,gestational weeks and operative time in 4 groups had no significant difference （P 〉 0.05）.The NRS score of rest incisional pain was equivalent among the 4 groups （P 〉 0.05）.The NRS score of dynamic incisional pain after operative 13 h in group S was significantly lower than that in group N[（3.6 ± 1.3） scores vs.（5.4 ± 1.2） scores]（P〈 0.05）.The NRS score of uterine contraction pain after operative 4,13 h in group N and group SK was lower than that in group S [（1.3 ± 1.0）,（1.1 ± 0.9） scores vs.（2.5 ± 1.1） scores and （1.6 ± 1.0）,（1.4 ± 0.9） scores vs.（2.9 ± 1.1） scores] （P 〈 0.05）.The RSS scores and incidence rate of dizziness were significantly higher in group N than those in group S （P 〈0.05）.No abnormality of new-horn infant was recorded in 4 groups.Conclusion Sufentanil combined with nonsteroidal antiinflammatory drugs can perform effective and safe analgesia on postoperative incisional and uterine contraction pain after cesarean section.