硬膜外复合咪达唑仑用于产科术后镇痛的临床观察

The effect of postoperative epidural analgesia with midazolam,fentanyl and dicaine in obstetric patients

目的观察硬膜外复合咪达唑仑用于产科术后镇痛的效果。方法将40例剖宫产病人随机分为两组,每组20例。所用的镇痛药配方I组为:咪达唑仑10mg、芬太尼0.5mg、丁卡因250mg以生理盐水稀释至250m l;Ⅱ组为:芬太尼0.5mg、丁卡因250mg以生理盐水稀释至250m l,分别从硬膜外腔持续泵入,速率为5m l/h。观察术后0h、2h、4h、8h、12h、24h、36h、48h的血压、心率、镇痛效果、镇静程度、感觉和运动阻滞程度及不良反应。结果两组的血压、心率、镇静程度在统计学上无显著差异(P>0.05),两组的镇痛效果在统计学上有显著差异(P<0.01),I组优于Ⅱ组,Ⅱ组中有3例镇痛效果较差,需追加镇痛药,两组均未出现嗜睡及其他不良反应。结论硬膜外持续泵入咪达唑仑-芬太尼-丁卡因复合液用于产科镇痛效果较好,不良反应少,适用于产科术后镇痛。

Objective To evaluate the effect of postoperative epidural analgesia with midazolam , fentanyl and dicaine in obstetric patients. Methods Forty patients undergoing caesarean section were randomly allocated to 1 of 2 groups （for each group,n = 20）. The following mixtures, in 250ml, were pumped continuously into epidural space at the rate of 5ml/h over 48h after surgery; midazolam 10mg ＋ fentanyl 0. 5mg ＋ dicaine 250mg ＋ saline in group Ⅰ, fentanyl 0.5mg ＋ dicaine 250mg ＋ saline in group Ⅱ. Blood pressure, heart rate, analgesia score, sedation score , the score of sense and motion were monitored at different time spots and side effects were noted postoperatively. Results Blood pressure, heart rate, sedation score , the score of sense and motion showed no differences between two groups （P 〉 0.05 ）. Analgesic effect in group Ⅰ was better than that in group Ⅱ （P 〈0.01 ）. Three patients in group Ⅱ had to be administered morphine to alleviate pain. No side effects appeared in both groups. Conclusions The effect of postoperative epidural analgesia with midazolam , fentanyl and dicaine in obstetric patients is superior to that with fentanyl and dicaine. There were no obvious side effects in the former method, which is adapted to postoperative epidural analgesia in obstetric patients.