改良腰硬联合麻醉在剖宫产术后镇痛的应用

Application of improving combined spinal-epidural anesthesia in cesarean section postoperative analgesia

目的比较腰硬联合麻醉传统法和改良法术后患者连续硬膜外自控镇痛(PCEA)的镇痛效果,为临床提供参考。方法60例ASAⅠ～Ⅱ级拟行剖宫产术的健康临产妇按传统法和改良法术后镇痛分为2组,Ⅰ组采用传统法,穿刺间隙为L3～4;Ⅱ组采用改良法,穿刺点为L1～2间隙硬膜外穿刺向头置管3cm,L3～4间隙腰麻。术后镇痛观察和比较项目:评估视觉模拟评分(VAS);改良Bromage评分;PCA的按压次数;患者总体评分:优、良、一般、差;出现的不良反应。记录时间分别为术后6、12、24、48h。结果腰硬联合麻醉传统的单点法和改良的双点法术后患者连续硬膜外自控镇痛(PCEA)的镇痛效应Ⅱ组满意率高于Ⅰ组。结论腰硬联合麻醉改良法术后PCEA镇痛效果佳,不良反应少,患者的术后总体满意率高,可以作为临床PCEA的一种较佳的选择。

Objective To compare and study of combined spinal-epidural anesthesia and analgesic effect of continuous epidural analgesia（PCEA） by improving combined spinal-epidural anesthesia. Methods By traditional laws and improved analgesia,60 cases of ASA Ⅰ-Ⅱ level of health parturient-women were divided into two groups：I group,the traditional meth- od, puncture gap for the L344, lI group, Improvement act, the puncture point L^-2 gap to the first epidural puncture and cathe- terization 3em, L3 -4 gap spinal anesthesia. And observed and compared of assessment of visual analogue scale（VAS） , modified Bromage score, the push number of PCA, total score in patients （ excellent, good, general, poor） , adverse reactions. The time were recorded after operation 6, 12,24,48 hours, respectively. Results The combined spinal-epiduralanesthesia traditional single-point method and improved two-point spells in patients after continuous epidural analgesia（PCEA） group of the analgesic effect of the satisfaction rate is higher than Ⅰ group Ⅱ group. Conclusion After improved operation of combined spinal-epidural anesthesia, the PCEA analgesic effect was good,and few adverse reaction. The overall satisfaction rate of postoperative patients was high. So it can be used as a better choice of clinical PCEA.