3种不同镇痛方法对剖宫产患者术后的影响

Effects of postoperative epidural analgesia with three different methods in cesarean section

目的:研究3种不同镇痛方法对剖宫产术后患者的影响。方法:195例患者术后随机分成A、B、C 3组;A组病人术后疼痛治疗肌肉注射哌替啶100 mg;B组患者术后经连续硬膜外导管注入0.25%罗比卡因5 ml,内含吗啡2 mg,氟哌利多1 mg,行单次硬膜外术后镇痛,同时拔除连续硬膜外导管;C组于术后前15 min经连续硬膜外导管注入0.25%罗比卡因5 ml+吗啡2 mg+氟哌利多1 mg,且保留硬膜外导管,接镇痛泵,行术后硬膜外自控镇痛(PCEA)。在术后6、12、244、8 h时间段观察3组镇痛效果(VAS评分)、肠蠕动恢复时间。结果:术后6、12、244、8 h,A组病人VAS评分明显高于B组和C组(P<0.01);术后244、8 h,B组VAS评分明显高于C组(P<0.05);C组肠蠕动恢复时间短于A组及B组(P<0.01)。结论:术后硬膜外自控(PCEA)应用于妇产科剖宫产术后患者镇痛优于单次吗啡硬膜外镇痛,更适用于术前对疼痛比较敏感或对手术痛有顾虑者。

Objective： To investiate effects of postoperative epidural analgesia with three different methods after cesarean section. Methods： One hundred and ninety-five patients undergoing cesarean section under combined epidural anesthesia were equally and randomly allocated in to A, B and C groups. Group A was performed 48 hours with pethidine. Group B was perfomed 48 hours with only one epidural infusion of 0.25~ ropivacaine 5 m/q-morphine 2 mg-kdroperidol 1 rag. Group C was perfomed 48 hours with a continuous epidural infusion of 0.25% ropivacaine 5 mlq-morphine 2 mgq-droperidol 1 mg, and was connected with a pump of analgesia, then perform patient-controlled epidural analgesia （PCEA）. The analgesia efficacy were evaluated and visual analog scale （VAS） of 6, 12, 24, 48 h were recorded. Result： The VAS score was significantly higher in group A than that in group B and group C. There were significant differences among three groups after 6, 12, 24, 48 h. The VAS score was significantly higher in group B than that in group C. There was significant difference among three group after 24, 48h. The duration by which the intestine resumed its motor function was greatly shorted in group C. Conclution.. The continuous epidural analgesia can improve analgesic effect of PCEA with few of complications, even adapt it to patient with preoperative pain.