剖宫产术后不同镇痛方法的效果比较

The effect of postoperative analgesia in patients with cesarean by different paregoric methods

目的观察不同镇痛方法对剖宫产术后产妇的镇痛效果。方法将剖宫产术分娩的产妇100例患者随机分组，每组各50例。采用自控硬膜外镇痛（PCEA）微量注射泵为PCEA组；采用自控静脉镇痛（PCIA）微量注射泵为PCIA组。观察并记录患者术后的疼痛情况、头痛头晕、恶心呕吐、术后排气、拔除尿管后的第1次排尿时间以及意外脱管等。结果PCEA组、PCIA组患者的平均手术时间分别为（53．5±8．5）min、（54．7±8．2）min，两组间手术时间差异无统计学意义（t=1．524，P〉0．05）；PCEA组视觉模拟评分（1．49±0．43）分明显高于PCIA组（1．13±0．56）分（t=2．119，P〈0．05）；PCEA组患者术后头痛头晕、恶心呕吐、皮肤瘙痒发生率（30．0％、16．0％、6．0％）明显高于PCIA组（16．0％、8．0％、2．0％）（t=2．223，t=2．313，t=2．283，均P〉0．05）；PCEA组第1次排气时间、第1次排尿时间[（24．56±8．77）h、（6．51±1．57）h]明显高于PCIA组[（19．29±8．16）h、（4．06±1．76）h]（t=2．445，t=2．415，P〈0．05）。结论静脉自控微量注射镇痛泵镇痛安全有效，有利于术后患者充分配合治疗和早期活动，促进早期康复。

Objective To observe the analgesic effect after cesarean section with different paregoric methods. Methods 100 cesarean patients were randomly divided into A and B group. A group adopted patient controlled epidura analgesia（PCEA） micro-injection pump;B group using patient controlled intravenous analgesia（PCIA） micro-injection pump, patients were observed and recorded for their pain, vomit disgustingly, exsufllation and the time of first urination or accidentally tube pull-out. Results The time of average surgery for A, B group were （ 53. 5 ± 8. 5 ） min, （54. 7 ± 8. 2） min, between the two groups was not significant （ t = 1. 524, P 〉 0. 05 ） ; A group of visual Analog score （ 1.49 ± 0. 43 ） points were significantly higher than B group （ 1.13 ± 0.56 ） points （ t = 2. 119, P 〈 0. 05 ） ; the incidence of headache, dizziness, nausea and vomiting, skin itching（ 30.0% , 16.0% ,6. 0% ） in A group were significandy higher than B group（ 16.0% ,8. 0% ,2. 0% ） （ t = 2. 223, t = 2. 313, t = 2. 283, all P 〉 0. 05 ） ; the time of A first exhaust, voiding time [ （ 24. 56 ± 8.77 ） h, （ 6. 51 ± 1.57 ） h ] in A group were significantly higher than B group [（19.29±8.16）h,（4.06±1.76）h]（t=2.445,t=2.415,P〈0. 05）.Conclusion PCIA methed was safe, effective and allowed patients to have early activities after treatment and to promote early rehabilitation. It should be promoted for cesarean section.