盐酸奈福泮在腰麻—硬膜外联合阻滞剖宫产术后镇痛中的应用

Analgesic effect of spinal-epidural nefopam hydrochloride on puerperae after cesarean section

目的观察盐酸奈福泮腰麻—硬膜外联合阻滞剖宫产手术后产妇的术后镇痛效果和安全性。方法选择剖宫产产妇90例,随机分为对照组(Ⅰ组n=30)给予氟哌利多5mg+3%氯普鲁卡因40 ml+生理盐水至100 ml、芬太尼组(Ⅱ组n=30)给予芬太尼0.3 mg+氟哌利多5 mg+3 %氯普鲁卡因40 ml+生理盐水至100 ml、奈福泮组(Ⅲ组n=30)盐酸奈福泮40 mg+氟哌利多5 mg +3%氯普鲁卡因40 ml+生理盐水至100 ml。术毕时经硬膜外导管泵人,2 ml/h,镇定时间15 min。观察记录镇痛效果、不良反应、下肢运动阻滞程度、肛门首次排气时间。结果Ⅱ组和Ⅲ组镇痛效果均优于Ⅰ组;Ⅲ组不良反应明显低于Ⅱ组;3组产妇下肢运动阻滞程度无统计学差异;肛门首次排气时间Ⅲ组明显短于Ⅱ组。结论盐酸奈福泮用于腰麻—硬膜外联合阻滞剖宫产术后镇痛优于芬太尼。

Objective To investigate the postoperative anaglesic effect and safety of nefopam hydrochloride on puerperae after cesarean section under spinal-epidural anesthesia. Methods Ninety puerperae undergoing selective cesarean section were randomly divided into 3 groups. PCEA with droperidol 5mg, 3% chloroprocaine 40ml added normal saline to 100ml was administrated in Group l （control group, n = 30） with fentanyl 0.3mg, droperidol 5mg, 3 % chloroprocaine 40ml added normal saline to 100 ml in Group Ⅱ （fentanyl group,n=30） with nefopam hydrochloride 40mg , droperido- 5mg,3% chloprocaine 40ml added normal saline to 100 ml in Group Ⅲ （nefopam group,n=30）. The analgesic mixtrue was pumped at the end of oparation, 2 ml/h,lock time 15 min. Analgesic effects, adverse effects, the degree of lower extremity motor block and anal exsufflation time were observed and recorded. Results The analgesic effects in group Ⅱ and Ⅲ were better than that in group Ⅰ The rate of adverse effects in group Ⅲ was much lower than that in group Ⅱ. The anal exsufflation time in groupⅢ was much shorter than that in group ⅡThere was no significant difference in the degree of lower extremity motor block between the three groups. Conclusion The postoperative anaglesia effect of nefopam hydrochloride PCEA on puerperae after cesarean section under spinal-epidural anesthesia is superior to fentanyl.