静脉自控镇痛不同用药组合对剖宫产妇术后镇痛效果的比较

Comparison of Postoperative Analgesic Effects of Patient-controlled Intravenous Analgesia with Different Analgesic Agent Combination for Cesarean Parturients

目的观察比较静脉自控镇痛(patient-controlled intravenous analgesia,PCIA)不同用药组合对剖宫产妇术后的镇痛效果和不良反应,以选择理想的PCIA用药组合。方法将60例剖宫产妇随机分为3组,每组20例。3组产妇术后均采取PCIA,A组镇痛药液选用酒石酸布托啡诺注射液8 mg;B组选用酒石酸布托啡诺注射液6 mg加氢溴酸高乌甲素注射液32mg;C组选用枸橼酸芬太尼注射液0.015 mg/kg。3组均加盐酸托烷司琼注射液10 mg,并用生理盐水稀释至100 mL。术后以2 mL/h速度持续泵注镇痛液。泵注前,A组与B组分别静脉注射酒石酸布托啡诺注射液1 mg作为负荷量,C组静脉注射枸橼酸芬太尼注射液0.05 mg作为负荷量。产妇按需按压PCIA泵,泵注量0.5 mL/次,锁定时间为15 min。PCIA实施过程中,排除静脉不通畅情况,以确保PCIA的有效实施。观察并记录手术后1,6,12,24,36,48 h的生命体征监测指标和不良反应的发生情况,并进行镇痛、镇静评分。镇痛评分用视觉模拟评分法(VAS)为标准,镇静评分采用Ramsey评分法。结果 3组产妇术后不同时间点的血压、心率、呼吸频率、脉搏血氧饱和度均无显著性差异。3组产妇术后不同时间点的VAS比较:手术后1 h和6 h的VAS值:C组<B组<A组(P<0.05);手术后12,24,3,48 h的VAS值基本相同(P>0.05);各组VAS均值均<3分。3组产妇术后不同时间点的Ramsey镇静评分均无显著性差异,均<3分(P>0.05)。3组产妇手术后按压镇痛泵次数:A组>C组(P<0.05)≈B组。3组产妇手术后恶心、呕吐、头痛、头晕的发生例数,C组>A组>B组(P<0.05);各组均无皮肤瘙痒和呼吸抑制发生。结论剖宫产术后芬太尼(0.015 mg/kg)的PCIA效果确切,但副作用较多;单纯布托啡诺(8 mg)的PCIA效果较差;布托啡诺(6 mg)加高乌甲素(32 mg)的PCIA效果良好,且副作用少。因此后者值得剖宫产术后PCIA应用。

Objective To compare the analgesic effects of patient-controlled intravenous analgesia （PCIA） with different analgesic agent combination for postoperative cesarean section pain to choose the optimal PCIA using analgesic agent combination. Methods Sixty parturients undergoing cesarean section were randomly divided into three groups （n= 20） to receive PCIA analgesic agent combination. Analgesic solution （100 mL） contained 8 mg of butorphanol tartrate （group A） or 6 mg of butorphanol tartrate plus 32 mg of lappaconitine hydrobromide （group B） or 0.015mg/kg of fentanyl citrate （group C）, in addition to 10 mg of tropisetron hydrochloride. In the end of procedure, lmg ofbutorphanol （group A and B） or 0.05 mg of fentanyl （group C） was intravenously injected followed by continuous pump infusion of analgesic solution in a rate of 2 mL/h. Receivers pressed pump bottom as needed to get a bolus does of 0.5 mL volume each time, with lockout time of 15 min. Vital signs, visual analogue scales （VAS）, Ramsey sedation score and adverse reactions were observed and recorded at 1 h, 6 h, 12 h, 24 h, 36 h and 48 h after procedure, respectively. Results There were no significant differences among three groups in blood pressure, heart rate, breathing rate and pulse blood oxygen saturation at each time-point （P〉0.05）. VAS value was lowest in group C and highest in group B （P〈0.05） at lh and 6h after procedure, and had no difference among three groups at postoperative 12 h, 24 h, 36 h and 48 h, with less 3 score for all the cases. Ideal and similar Ramsey sedation score was recorded in the whole observation among three groups （P〉0.05）, with less 3 score for all the cases. The times to press pump button was more in group A than that in group B and C （P〈0.05）. The occurrence of nausea, vomiting, headache and dizziness was more frequent in group C （P〈0.05）than that in group A and B. No skin itch and respiratory depression occurred for all the cases. Conclusion The results of the present study demonstrates that PCIA using fentanyl （0.015 mg/kg） produces powerful analgesic effect, as well as with frequent occurrence of adverse reactions. PCIA with butorphanol （8 mg） exerts weak analgesic effect and rare adverse reactions. Combination of butorphanol （6 mg） and lappaconitine （32 mg） for PCIA provides both favorable analgesic effect and less adverse reactions, which is recommendable for clinical use.