剖宫产术后不同镇痛方法的效果比较

Comparison of the effects of different analgesia methods after cesarean section

目的：比较3种不同配伍和给药途径的术后镇痛方法对剖宫产术后产妇镇痛程度及镇痛持续时间的影响。方法：选择行子宫下段剖宫产术产妇300例,年龄19~40岁,随机均分为RS组（罗哌卡因178.8 mg,舒芬太尼0.1 mg）,MD1组（0.5%布比卡因1.3~1.7 m l,加吗啡0.4 mg,氟哌利多0.8 mg注入蛛网膜下腔）,MD2组（0.5%布比卡因1.5 m l腰麻,术毕硬膜外腔注入吗啡2 mg,氟哌利多1 mg）。术后2、4、12、24、48 h时点监测HR、SBp、DBp、RR、SpO2及静态疼痛视觉模拟评分（VASr）、动态疼痛视觉模拟评分（VASm）、警觉/镇静评分（OAA/S）变化情况;统计术后恶心、呕吐、呼吸抑制、瘙痒的发生情况;记录镇痛实际持续时间。结果：在24、48 h,RS组VASr和VASm低于MD2组（P〈0.01）;24、48 h MD1组VASr和VASm低于MD2组（P〈0.05）。MD2组镇痛持续时间显著短于RS组和MD1组（P〈0.01）。结论：3种不同配伍及给药途径的镇痛方法,用于剖宫产术后镇痛均安全、有效,罗哌卡因联合舒芬太尼镇痛效果较好,在基层医院以吗啡、氟哌利多注入蛛网膜下腔镇痛更具实用价值。

Objective： To compare the analgesia degree and the analgesia duration of three different analgesia methods with different compatibility of drugs and different routes of administration in positive-cesarean section.Methods： 300 puerperas with lower uterine segment cesarean section,aged from 19 years old to 40 years old,were randomly and averagely devided into RS group（Ropivacaine 178.8mg,Sufentanil 0.1 mg）,MD_1 group（0.5%Bupivacaine 1.3～1.7 ml plus Morphine 0.4 mg and Droperidol 0.8 mg injected into the subarachnoid space） and MD_2 group（0.5% Bupivacaine 1.5ml injected the subarachnoid space and Morphine 2 mg plus Droperidol 1mg injected into the epidural space immediately）.After operation,HR,SBp,DBp,RR,SpO_2 of puerperas were monitored at point 2 h,4 h,12 h,24 h and static pain visual simulation score（VASr）,motion pain visual simulation score（VASm）,alertness/ conscious sedation（OAA/S）were recorded.And postoperative nausea、vomiting、respiratory depression,itching and actual analgesia duration were recorded.Results： At 24 h,48 h,VASr and VASm were significantly depressed in group RS than in MD_2（P0.01）.At 24 h,48 h,VASr and VASm were significantly depressed in group MD_1 than in MD_2（P0.05）,analgesia duration were significantly shorter in MD_2 than in RS and MD_1（P0.01）,vital signs were stable in postoperative analgesia,and OAA/S.Respiratory depres-sionincidence was not statistically difference.Conclusion： Three different analgesia methods with different compatibility of drugs and different routes of administration were all safe and effective in positive-cesarean section analgesia,and ropivacaine plus sufentanil is more effective.