吗啡在产妇自控硬膜外镇痛与单次硬膜外镇痛对剖宫产产妇子宫缩复的影响

Effects of patient-controlled epidural analesia and single-dose epidural infusion of morphine on uterine contractions in patients of cesarean section

目的 探讨单次和持续少量吗啡注入硬膜外腔对剖宫产术后产妇子宫缩复、产后出血量的影响。方法 2 44例孕产妇随机分为两组各 12 2例 ,Ⅰ组术毕单次量吗啡、甲氧氯普胺、新斯的明、生理盐水稀释后注入硬膜外腔 ,Ⅱ组术毕与硬膜外导管连接设置好的PCEA装置。结果 子宫缩复率分别为 77 0 4%、90 98% (P <0 0 5 )。两组出血量≥ 5 0 0ml者分别占 17 2 1%和 3 2 7%。催产素追加率分别为 13 93%和 1 6 3% ,最大追加剂量 6 0IU～ 80IU。组间比较P <0 0 1,差异显著。结论 单次注射吗啡 ,抑制子宫收缩 ,增加产后出血量及催产素追加率。PCEA为持续给药 ,使吗啡和局麻药协同 ,降低两药副反应 ,符合药代动力学给药规律和个体化用药原则 。

Objective\ To investigate the effects of single-dose epidural infusion of morphine and patient-controlled epidural analgesia(PCEA)on the postpartum uterine contractions and postpartum haemorrhage in patients of cesarean section.Method\ 244 pregnant women were randomly divided into two groups.Group Ⅰ,10ml 0.03% morphine mixed fluid of was injected into the epidural space after cesarean section.Group Ⅱ,0.006% morphine mixed fluid was injected into patients by PCEA for postoperative analgesia.Results\ The rates of good uterine contractions in the two groups were 77.04% and 90.98% respectively(P<0.05);the rates of postpartum haem-orrhage(≥500ml)were 17.21% and 3.27% respectively(P<0.01),the rates of additional oxytocin use were 13.93% and 1.63% respectively(P<0.01).The maximum additional dosage of oxytocin was 60IU～80IU.Conclusion\ Single-dose use of morphine can inhibit the uterine contractions and increase the quantity of uterine bleeding.PCEA can continuously release the drugs and decrease the side effects on the uterus.