缩宫素复合罗哌卡因用于剖宫产术后硬膜外自控镇痛的临床观察

Clinical observation of oxytocin combined with ropivacaine in postoperative patient-controlled epidural analgesia after cesarean section

目的观察缩宫素与罗哌卡因配伍用于术后硬膜外自控镇痛的效果。方法选择硬膜外阻滞剖宫产90例,随机分为3组,每组30例。A组为0.18%甲磺酸罗哌卡因,B组为10 U缩宫素+0.18%甲磺酸罗哌卡因,C组为对照组0.5%曲马朵+0.18%甲磺酸罗哌卡因,持续量2.0 ml/h,PCA为0.5 ml/15 min,记录24 h、48 h疼痛视觉模拟评分(VAS)、疼痛语言评分、PCA次数及产妇主观不适感。结果A、B、C 3组24 h VAS评分分别为(4.3±0.6)、(2.1±0.8)、(1.9±0.6);优良率(VAS<3)分别为23.3%(7/30例)、83.3%(25/30例)、86.7%(26/30例)。B组术后镇痛优良率明显优于A组(P<0.01),与C组镇痛效果相当(P>0.05)。结论缩宫素与甲磺酸罗哌卡因联合用于剖宫产术后硬膜外镇痛有良好的术后镇痛作用,其镇痛效果与曲马朵大体相当,不良反应小于曲马朵。

Objective To evaluate the efficacy of postoperative patient-controlled epidural analgesia with oxytocin （OT） and ropivacaine mesylate after cesarean section. Methods 90 parturients undergoing epidural block for cesarean section were randomly assigned to three group（ n = 30,each group）. Group A was given 0. 18% ropivacaine mesylate,group B 10 U OT ＋0.18% ropivacaine mesylate,group C （controll group） 0.5% tramadol ＋0.18% ropivacaine mesylate. Background dose was 2.0 ml/h,PCA bolus 0.5 ml,lockout time 15 min. The VAS,VRS,the number of PCA demand during the first 24 h,48 h and the side-effects were recorded. Results The VAS of the groups A, B and C were （ 4.3± 0.6 ）、 （ 2.1 ± 0.8 ） and （ 1.9 ±0.6） respectively at 24 h and the excellent and good rate （ VAS 〈 3 ） were 23.3% （ 7/30 cases ） , 83.3% （25/30 cases） and 86.7% （26/30 cases）. The percentage of satisfied analgesia in group B was significant higher then that in group A（P 〈0.01 ）,and no significant differences between group B and C （P〉0.05）. Conclusion Oxytocin combined with 0. 18% ropivacaine mesylate can provide a satisfied analgesia during PCEA after cesarean section. The analgesic effect approximates to tramadol, but less side effects than tramadol.