蛛网膜下腔吗啡和连续硬膜外芬太尼用于剖宫产术后镇痛效果的比较

Comparison of curative efficacy between intrathecal morphine and continuous epidural fentanyl for postoperative analgesia of cesarean section

目的:比较蛛网膜下腔吗啡和连续硬膜外芬太尼用于剖宫产术后镇痛效果。方法:选择60例在腰麻下行剖宫产的产妇并分为3组,每组各20例。吗啡组以0.5%布比卡因2.5ml加吗啡0.1mg作为蛛网膜下腔麻醉给药,对照组和芬太尼组,只以0.5%布比卡因2.5ml作为蛛网膜下腔麻醉给药,芬太尼组产妇术后通过镇痛泵给于芬太尼0.5mg加0.25%布比卡因80ml以2ml/h持续硬膜外腔给药镇痛。术后48小时,观测所有产妇首次要求追加镇痛药的时间及不良反应。结果:从腰麻开始到首次要求追加镇痛药的时间,芬太尼组(41±14)小时明显长于吗啡组(24±17)小时,吗啡组明显长于对照组(5.8±4.8)小时。未见明显不良反应。结论:腰麻下行剖宫产的产妇在术后镇痛中,持续硬膜外注入芬太尼比蛛网膜下腔注入吗啡产生更长时间的镇痛作用而且不增加不良反应。

Objective:To compare the curetive efficacy between intrathecal morphine and continuous epidural fentanyl for postoperative analgesia of cesarean section.Methods:60 parturients who underwent cesarean section under spinal anesthesia were divided into 3 groups,with 20 cases in each group.Group C served as control,group M received intrathecal morphine and group F received continuous epidural fentanyl.For spinal anesthesia,isobaric 0.5%bupivacaine 2.5ml combined with morphine 0.1mg was injected intrathecally via L2/3 or L3/4 intervertebral space in group M,whereas bupivacaine alone was injected in group C and F.Postoperatively,women in group F veceived continuous epidural infusion 0.25%bupivacaine 80ml coupled with fentanyl 0.5mg at the rate of 2ml/hour by using a balloon infuser incorporating a PCA circuit.All parturients were followed up with regared to requirement of additional analgesics and development of adverse reaction until 48 hours after operation.Results:The time from spinal anesthesia to the first requirement of additional analgesic in group M(21±13)hours was significantly lower than that in group F(39±12)hours,but which was significantly longer than that in group C(6.4±3.2)hours,obvious adverse reaction was not found.Conclusion:Continuous epidural fentanyl exerts analgesic effect of longer time,which is superior to intrathecal morphine.