超前应用盐酸丙帕他莫预防剖宫产术后宫缩痛的临床研究

The preemptive analgesia of propacetamol hydrochloride on contractions pain after caesarean section

目的观察在剖宫产手术中超前应用盐酸丙帕他莫预防术后宫缩痛的临床疗效。方法选择剖宫产手术术后行硬膜外自控镇痛(PCEA)患者60例,随机分为两组:丙帕他莫+PCEA组(P-E组,n=30)和单纯PCEA组(E组,n=30)。全部病例均在硬膜外麻醉下手术,术毕均于硬膜外腔留置导管内注入镇痛药物(0.125%甲磺酸罗哌卡因+舒芬太尼1μg)5 ml后接镇痛泵。术后镇痛泵药物配方:舒芬太尼40μg+0.12%甲磺酸罗哌卡因+生理盐水共100ml;镇痛泵给药模式:维持量为2 ml/h,单次负荷剂量为0.5 ml,锁定时间为15 min。E-P组剖宫产手术在婴儿取出后,丙帕他莫2 g溶于100 ml盐水中15 min内静脉输入;E组剖宫产手术在婴儿取出后,应用100 ml盐水15 min内静脉输入。观察指标:①应用VAS疼痛评分法观察两组术后30 min、2 h、6 h、12 h的手术伤口疼痛强度;②应用VAS疼痛评分法观察两组术后30 min、2 h、6 h、12 h的宫缩痛疼痛强度;③术后宫缩痛评定标准对比观察;④观察两组术后2 h内恶心、呕吐、瘙痒、发热、呼吸抑制等并发症的发生率。结果 E-P组与P组的伤口镇痛效果无显著性差异(P>0.05),而E-P组的宫缩痛的发生率和疼痛强度明显低于P组(P<0.05),且恶心、呕吐、发热等发生率低于P组,差异有显著性(P<0.05)。结论超前应用丙帕他莫对剖宫产术后宫缩痛的发生具有预防作用,可有效控制宫缩痛的疼痛程度,同时减少副作用发生率。

Objective To explore the preemptive analgesia of propacetamol hydrochloride on contractions pain after caesarean section（CS） and related side effects.Methods Sixty pregnant women undergoing CS and epidural patient controlled analgesia（EPCA） were included into this study.All these patients were randomly divided into groups of receiving propacetamol hydrochloride and EPCA（group P-E,n = 30） or only EPCA（group E,n = 30）.CS was performed under epidural anesthesia.A total of 1ug sufentanil and 6.25 mg ropivacaine in 5 ml was injected into the epidural space and an EPCA pump was connected with the catheter and when CS was finished.The EPCA pump contained sufentanil 40 ？ g,ropivacaine 120 mg,and normal saline in 100 ml.The setting of EPCA pump was 2 ml per hour for the basal rate,a bolus of 0.5 ml for one demand,and 15 min for one locking time.Pregnant women in group EP received intravenous propacetamol hydrochloride 2 g in 100 ml normal saline within 5 minutes after the baby was removed,whereas pregnant women in group E received normal saline 100 ml.Visual analogue scale（VAS） of incision pain and contractions pain were recorded at postoperative 30 min,2 h,6 h,and 12 h.Postoperative contractions pain scale was evaluated and analyzed.Side effects at postoperative 2 h such as nausea,vomiting,pruritus,fever,and respiratory depression were also observed.Results There was no significant difference in VAS of incision pain between two groups（P 0.05）.The incidence and pain intensity of contractions pain in group P-E were significantly lower than those in group P（P 0.05）.Side effects in group P-E were significantly fewer than those in group（P 0.05）.Conclusion Propacetamol hydrochloride has good preemptive analgesic effect and is safe and effective for pregnant woman to prevent from contractions pain after CS.