喷他佐辛硬膜外PCA对剖宫产产妇术后子宫收缩痛的影响

Effects of postoperative patient-controlled epidural analgegia using pentazocine on uterine contraction pain after Cesarean section

目的观察0.1%喷他佐辛或0.02%吗啡配伍0.2%左旋布比卡因硬膜外患者自控镇痛(PCEA)对剖宫产产妇术后伤口疼痛与子宫收缩痛的镇痛效果和不良反应。方法择期剖宫产产妇40例,随机分成P组、M组,各20例。P组采用0.1%喷他佐辛配伍0.2%左旋布比卡因,M组采用0.02%吗啡配伍0.2%左旋布比卡因行PCA,PCA采用LCP模式。分别记录开启PCA泵后各时段的按压次数与实际有效次数及1 h、2 h、4 h、8 h、16 h、24 h的伤口疼痛与子宫收缩痛的VAS评分、Ramesay镇静评分,记录产妇对PCA的综合满意度与不良反应。结果两组产妇静息及动态VAS评分差异无统计学意义,子宫收缩痛VAS评分P组高于M组(P<0.05);在整个PCA期间P组无1例产妇出现恶心、呕吐及瘙痒等不良反应,而M组有8例(40%)出现恶心、呕吐,3例(15%)出现瘙痒。两组均无镇静过度现象。结论剖宫产手术采用0.1%喷他佐辛或0.02%吗啡配伍0.2%左旋布比卡因行PCEA对产妇的静息及动态疼痛均能达到良好的镇痛,对子宫收缩痛.吗啡PCEA优于喷他佐辛PCEA,但其恶心、呕吐及瘙痒等不良反应发生率较高。

Objective To investigate the pain control efficiency and adverse effects of postoperative patient-controlled epidural analgesia using 0.1% pentazocine or 0.02 % morphine add to 0.2 % levobupivacaine on wound pain and uterine contraction pain after Cesarean section （CS）. Methods Forty parturient women undergoing selective CS were randomly divided into two groups. Postoperative patient-controlled epidural analgesia （PCEA） using 0. 1% pentazocine added to 0.2 % levobupivacaine was received in group P, The model of PCA was LCP with loading dose 5ml＋continuous infusion dose 2ml＋bolus dose 2ml. Postoperative PCEA using 0.02% morphine added to 0. 2% levobupivacaine was received in group M. The model of PCA was LCP with loading dose 5ml ＋continuous infusion dose 1ml＋bolus dose lml. Visual analogue scale （VAS） of wound pain and uterine contraction pain, Ramesay Score were recorded at 1, 2, 4, 8, 16 and 24 hr after CS. The times of self administration bolus （D1） and effective times （D2） were recorded at 0-1hr, 1-2hr, 2 -4hr, 4 - 8hr, 8 - 16hr, 16 - 24hr after CS . Adverse effects including nausea and vomiting （PONV） and pruritus were investigated. The overall satisfactory score of parturients on PCA was recored. Results The uterine contraction pain scores of parturients in morphine group was significant lower and incidences of PONV and pruritus was higher than those in the pentazocine group （P 〈0. 05）. However, there was no significant difference between the two groups in wound pain scores and their overall satisfaction. The motor function of all patients was recovered in 6 hr after CS：Conclusions Similar effect of postoperative patient-controlled epidural analgesia using 0. 1%pentazocine or 0.02% morphine added to 0.2% levobupivacaine is achieved on wound pain after CS. PCA using 0.02 % morphine added to 0.2% levobupivacaine was more effective on the control of uterine cramps but with increased adverse effects in parturients undergoing CS compared with PCA using pentazocine.