硬膜外-静脉联合镇痛在剖宫产术后的应用

Application of combined analgesia by epidural and vein way after cesarean

目的探讨剖宫产手术后硬膜外-静脉联合镇痛的效果和相关的并发症。方法154例患者随机分为静脉镇痛组(Ⅰ组)51例,硬膜外镇痛组(Ⅱ组)50例和硬膜外-静脉联合镇痛组(Ⅲ组)53例。观察并记录3组患者术后第2、8、16、24、32和48小时的镇痛效果以及无创平均动脉压(BP)、心率(HR)、脉搏氧饱和度(SpO2)。镇痛效果采用视觉模拟评分法(VAS)评估患者翻身、咳嗽等动态疼痛程度。观察并记录患者术后48h内的恶心、呕吐、皮肤瘙痒、嗜睡、尿潴留、呼吸抑制、下肢乏力等并发症以及胃肠功能恢复时间和48h累计用药量。结果3组患者均取得良好的镇痛效果,VAS评分Ⅱ、Ⅲ两组各时点显著低于Ⅰ组(P<0.05,P<0.01)。术后均出现了可能与镇痛相关的并发症,Ⅰ组嗜睡的发生率显著高于Ⅱ组(P<0.05),恶心或呕吐以及尿潴留的发生率,Ⅲ组明显低于其他两组(P<0.05),Ⅱ组下肢乏力显著多于Ⅰ、Ⅲ两组(P<0.05),术后胃肠功能恢复时间Ⅰ组(35.6±12.4)h和Ⅲ组(33.7±10.8)h显著高于Ⅱ组(46.6±13.2)h(P均<0.01),48h累计用药量Ⅲ组(82.3±17.6)ml少于Ⅰ组(107.8±23.4)ml(P<0.01)。结论硬膜外-静脉联合镇痛效果确切且并发症较少,值得临床进一步研究应用。

Objective To investigate analgesic effect and related complication of combined analgesia by epidural and vein way after operation. Methods 154 patients were randomly divided into vein analgesia group （group Ⅰ , n = 51）,epidural analgesia group （group Ⅱ , n = ：50） and combined analgesia group by epidural and vein way （group Ⅲ, n = 53）. The post operative analgesic effect,non-traumatic mean arterial blood preasure （BP）,heart rate （HR） ,pulse oxygen saturation （SpO2） in three groups were observed and recorded at 2,8,16,24,32 and 48 h after operation.The dynamic pain such as patients turn over and cough were evaluated by visual analogue scales （VAS）. The comphcations in 48 h after operation （ such as nausea, vomit, skin itch, drowsiness, urinary retention, respiratory depression and lower limbs debilitation） ,the time of gastrointestinal function recovery and accumulative total drug consumption were observed and recorded. Results All patients in three groups obtained satisfactory effect. The scores by VAS at all time-point in group Ⅱ and group Ⅲ were decreased obviously than those in group Ⅰ （ P 〈 0.05 or P 〈 0.01 ）.Analgesia-related comphcations were found in three groups. The incidence of drowsiness in group I increased sigeificantly than that group Ⅱ （ P 〈 0.05）. Among three groups, the incidence of nausea or vomiting and urinary retention in group m and the incidence of lower limbs debilitation in group Ⅱ was the lowest （ both P 〈 0.05）. The time of stomach intestine functional recovery after operation in group Ⅰ and group m was shortened obviously, as compared with that in group Ⅱ （both P 〈0.01）.Accumulative total drug consumption in group m was cut down notably, as compared with that in group Ⅰ （ P 〈0.01）.Conclusion Combined analgesia by epidural and veinway has less comphcations and definite effect, which deserves further clinical research.