探讨曲马多替代吗啡用于剖宫产术后PCEA的影响

To evaluate the effects of Tramadol use after the Cesarean section supersede Morphine

目的探讨曲马多替代吗啡用于剖宫产术后硬膜外自控镇痛(patientcontrolledepiduralanalgesia,PCEA)的可行性。方法选择60例ASAⅠ一Ⅱ级足月产妇,在硬膜外麻醉下施行剖宫产手术。术毕随机分为三组:Ⅰ组(非PCEA)术毕拔除硬膜外导管回病房;Ⅱ组(用吗啡的PCEA):0.15%布比卡因+吗啡0.05mg/ml+氟哌利多0.05mg/ml,Ⅲ组(用曲马多的PCEA组):0.15%布比卡因+曲马多2mg/ml+氟哌利多0.05mg/ml。两组设置都为负荷量10ml,持续量为2ml/h,PCA为0.5ml/次,锁定时间为15分钟。记录术后24h、48h两时间点疼痛视觉模拟评分,子宫高度,泌乳量。记录满意视觉模拟评分,初乳时间,肠蠕动恢复时间,PCA次数及病人主观不适。结果Ⅱ、Ⅲ组与Ⅰ组镇痛效果差异有显著性意义(P<0.05),Ⅱ组与Ⅲ组镇痛效果差异无显著性意义(P>0.05);而满意视觉模拟评分、初乳时间、24h泌乳量、肠蠕动恢复时间,Ⅱ、Ⅲ组明显优于Ⅰ组,均差异有显著性意义(P<0.05)。Ⅱ组嗜睡皮肤瘙痒发生率多于Ⅲ组,两者差异有显著性意义(P<0.05)。而48h泌乳量,三组差异无显著性意义(P>0.05):在恶心呕吐、呼吸抑制、腹胀的发生率Ⅱ、Ⅲ组无显著性差异(P>0.05)。结论曲马多替代吗啡用于剖宫产术后PCEA是安全有效的,有利于产妇产后健康的恢复和哺乳。

Objective To evaluate that Tramadol use to substitute Morphine after the Cesarean Section at patient controlled epidural analgesia （PCEA） is useful. Methods 60 ASA Ⅰ- Ⅱ pregnant women is full due date, at epidural analgesia to have Caesar, were allocated into three groups （n=20 in each）at the time after the operation. Group Ⅰ （No PCEA）： pull out the epidural tube then send back ward. Group Ⅱ（PCEA use Morphine）： 0.15% Bupivieaine＋Morphine0.05mg/ml＋Dropefido10.05mg/ml; Groupll （PCEAuse Tramadol）： 0.15% Bupivicaine＋Tramado12mg/ml＋ Droperidol 0.05mg/nd. Two groups all arrange the load amount is 10mi, the continuous amount is 2ml/h PCA is 0.5ml/time, the lock time is fifteen minutes. Record the maximal pain score by VAS, the height of womb, the amount of milk secretion. Record the maximal satisfaction score by VCS, the time of first milk, the time of peristalsis recover, the number of times of PCA and the uncomfortable of patient＇s feeling, Results Statistically significant different was found between the Group Ⅰ to Group Ⅱ and Group Ⅲ in respect to the result of pain controlled, the maximal VCS score, the time of fast milk, the amount of milk secretion in 24 hours, the time of peristalsis recover. （P〈0.05）. And no statistically significant difference was found between the Group Ⅱ and Group Ⅲ in respect to the result of pain controlled （P〉0.05）. 3 patients were found sonmohnce in Group Ⅱ （15%）, 3 patients were found itch at skin in Group Ⅲ（15%）, and Group IR found none, there are statistically signifieant different was found between the two groups（P〈0.05）. The other side effects such as nausea / vomiting respiratory depression and gastric distention were similar between the two groups. Conclusions Tramadol was to substitute Morphine after the Cesarean Section at PCEA is useful and safe.