硬膜外负荷量吗啡加芬太尼应用于剖宫产术后镇痛的观察

Observation on postoperative analgesia of cesarean section with maintenance dose of epidural morphine and fentanyl

目的观察预充负荷量吗啡和芬太尼复合液对吗啡术后镇痛的影响。方法选择剖宫产手术80例,年龄23～34岁,ASAⅠ～Ⅱ级,无心、肺、肾及神经系统疾病,无长期服用镇痛药和镇静药病史,均采用硬腰联合麻醉,根据负荷量的不同随机分为吗啡组(M组)和吗啡+芬太尼组(F+M组),负荷量配方:M组吗啡2mg+昂丹司琼4mg稀释到5mL,F+M组吗啡1mg+芬太尼0.1mg+昂丹司琼4mg稀释到5mL。采用视觉模式评分法评估产妇镇痛效果,观察2组患者不良反应。结果 M组与F+M组VAS评分在1h和2h差异有统计学意义(P(0.01,P(0.05),4h、8h、12h2组患者VAS评分差异无统计学意义(P(0.05)。2组患者均无呼吸抑制,恶心、呕吐和瘙痒发生率差异均无统计学意义(P(0.05)。结论在负荷量中吗啡和芬太尼联合使用既能够明显增强术后早期镇痛作用,又不会明显增加稍后镇痛泵中吗啡持续应用所产生的不良反应,值得推广应用。

Objective To observe effect of pre - charge maintenance dose of morphine and fentanyl to postoperative analgesia of morphine . Methods To choose 80 cases of cesarean section with a age range of 23 - 34, ASA I - II, no heart, lung, kidney or nervous system disease, no medical history of long - term using any analgesic or sedative, and combined spinal - epidural anesthesia adopted for all cases. According to the differences of loading, they were grouped into Morphine Group （ M Group） and Morphine ＋ Fentanyl Group （ F ＋ M Group）. Loading Ingredients ： M Group： 2mg Morphine ＋ 4 mg Ondansetron （ diluted to 5 ml） ; F ＋ M Group： lmg Morphine ＋ 0.1 mg fentanyl ＋ 4 mg Ondansetron （diluted to 5 ml）. Adopting visual pattern score to evaluate the effects to lying - in women and to observe adverse reactions of the two groups. Results There was marked difference on VAS score in lh and 2h between M Group and F ＋ M Group （P 〈 0. 01, P 〈 0. 05） , and there was no statistical difference on VAS score in 4h, 8h and 12h between the two groups （P 〉 0.05）. There was no statistical difference on incidence rate of respiratory depression, nausea, vomiting, and itching between the two groups （P 〉 0.05）. Conclusion With maintenance dose, the combined use of morphine and fentanyl can obviously strengthen early postoperative analgesic effect but do not obviously increase side effect generated by application of morphine in analgesic pump later. So it is worth popularizing and applying.