几种剖宫产术后镇痛方法的比较

Analgesia after Casearean Operation： Comparison of Several Methods

目的探讨适合剖宫产术后镇痛的理想方案。方法360例孕妇需剖宫产者分为静脉镇痛组和硬膜外镇痛组（吗啡组、芬太尼组），每组120例。静脉镇痛组（I组）：芬太尼0．8mg＋氟哌利多2．5mg＋生理盐水（NS）至100ml，2ml／h；硬膜外镇痛组（芬太尼组）（Ⅱ组）：芬太尼0．8mg＋0．75％左旋布比卡因10ml＋NS至100ml，2ml／h；硬膜外镇痛组（吗啡组）（Ⅲ组）：吗啡6mg＋0．75％左旋布比卡因10ml＋盐酸异丙嗪12、5mg＋NS至60ml，1ml／h，手术结束前10min硬膜外腔给饱和量（吗啡1，5mg＋盐酸异丙嗪5mg＋NS至10ml，根据产妇情况一次注入7～10ml）。结果各组镇痛效果差异明显，硬膜外镇痛吗啡组〉硬膜外镇痛芬太尼组〉静脉镇痛组，副作用发生率Ⅰ组稍高于Ⅱ组，Ⅱ组稍高于Ⅲ组（P〈0.05），皮肤瘙痒发生率Ⅲ组稍大于Ⅰ、Ⅱ组（P〉0．05），锥体外系发生率Ⅰ组大于Ⅱ、Ⅲ组（P〈0．05）。结论硬膜外吗啡镇痛组效果优良，吾4作用发生率低，易被产妇接受，适宜剖宫产术后镇痛。

Objective To study an ideal program which is suitable for analgesia after caesarean operation. Methods 360 pregnant women who need caesarean operation were divided into intravenous analgesia group and epidural analgesia group （morphine group and fentanyl citrate ingection group） in random with 120 women each group. Intravenous analgesia group （ Group I ） ：give an injection of 0.8mg fentanyl ＋ 2. 5mg droperidol ingeetion ＋ NS up to lOOml with a speed of and per hour. Epidural analgesia group （ Fentanyl citrate ingection group） （ Group Ⅱ ） ：give an injection of 0.8mg fentanyl citrate ingection ＋ 10ml levobupivacaine ingection whose density is 0.75% ＋ NS up to lOOml with a speed of 2rnl per hour. Epidural analgesia group （ Morphine Group） （Groupm） ：give an injection of 6mg morphine ＋ 10ml lerobuicacaine ingection whose density is 0.75% ＋ 12, 5rag promethazine hydrochloride ingection ＋ NS up to 60ml with a speed of lml per hour. The operation lasted about 10 minutes before the epidural space was given a satarable amount（ 1.5mg morphine ＋5mg promethazine hydrochloride ingection ＋ NS up to 10ml. Give an injection of 7 - 10ml each time according to the pregnant women＇s situation）. Results The differences in the analgesia effects of each group is obvious. The rate of side effects in Group I is slightly larger than Group II whilethe rate of side effects in Group II is slightly larger than Group m （P 〈0 .05） The rate of outside of the vertebal in Group I is larger than Group II and Group m （P 〉0. 05） Conclusion Epidural morphine analgesia group is suitable for analgesia after caesarean operation and easily accepted by the pregnant women because of its excellent effects and low side effects.