曲马多辅助硬膜外麻醉用于剖宫产术的疗效观察

Efficacy observation of Tramadol epidural auxiliary anesthesia applied for cesarean section

目的探析临床剖宫产术应用曲马多辅助硬膜外麻醉的镇痛以及预防术后寒战的效果。方法选取台州市博爱医院2012年1-12月收治的98例需行剖宫产手术产妇为研究对象，采用随机数字法将其分为对照组和观察组．对照组49例加用吗啡，观察组49例加用曲马多，观察两组患者术后生命体征、寒战以及不良反应发生情况。结果观察组寒战发生率为16．33％，明显低于对照组的44．90％（χ2=9．42，P〈0．01）；观察组产妇术后4、8、12、24h平均视觉模拟评分[（2．5±0．6）、（2．3±0．6）、（1．8±0．4）、（1．4±0．5）分]和对照组产妇[（2．4±0．5）、（2．2±0．4）、（1．9±0．5）、（1．5±0．6）分]比较差异无统计学意义（P〉0．05），观察组产妇术后4、8、12、24h平均镇痛评分[（1．7±0．5）、（1．9±0．6）、（2．1±0．6）、（1．7±0．6）分]与对照组[（2．1±0．5）、（2．3±0．6）、（2．5±0．7）、（2．1±0．5）分]比较差异有统计学意义（P〈0．05）；在术后各时段血压、心率保持平稳（P〉0．05）；对照组不良反应发生率为53．06％，观察组无一例发生不良反应，差异有高度统计学意义（χ2=35．39，P〈0．01）。结论临床上硬膜外注入曲马多能有效地预防术后产妇发生寒战且减轻其严重程度，同时具有良好的镇痛效果，无不良反应发生，效果明显优于吗啡，值得在临床实践中广泛的推广和应用。

Objective To explore analgesic effect of Tramadol auxiliary epidural anesthesia applied in clinical cesarean sec- tion and efficacy to prevent postoperative shivering. Methods 98 eases of puerperal requiring maternal cesarean section oper- ations admitted to Taizhou Bo＇ai Hospital from January to December in 2012 were randomly selected to be research objects, the patients were divided into control group and the observation group by random number method, 49 eases of patients in the control group were added morphine, while 49 cases of patients in the observation were administrated with Tramadol. Results The occurrence rate of shivering in the observation group was 16.33%, which was significantly lower than the value of 44.90% in the control group （χ2=9.42, P 〈 0.01）; the comparison differences between average VAS scores of maternity patients in the observation group in 4, 8, 12, 24 hours after operation with values of （2.5±0.6）, （2.3±0.6）, （1.8±0.4）, （1.4±0.5） points and those in the control group in 4, 8, 12, 24 hours after operation with values of （2.4±0.5）, （2.2±0.4）, （1.9±0.5）, （115±0.6） points were not significant （P 〉 0.05）; the average SS scores of maternity patients in the observation group in 4, 8, 12, 24 hours after op- eration with values of （1.7±0.5）, （1.9±0.6）, （2.1±0.6）, （1.7±0,6） points were less than those in the control group in 4, 8, 12, 24 hours after operation with values of （2.1±0.5）, （2.3±0.6）, （2.5±0.7）, （2.1±0.5） points, and the comparison differences were sig- nificant （P 〈 0.05）; the blood pressure, heart rate kept smooth （P 〉 0.05）; the occurrence rate of adverse reaction in the con- trol group was 53.06%, no adverse reaction occurred in the control group, and the comparison difference was significant （χ2= 35.39, P 〈 0.01）. Conclusion Clinical epidural injection of Tramadol can effectively prevent postoperative maternity patients from have shivering and mitigate its severity, and it also has great analgesic effect without the occurrence of adverse reactions, its effect is much better than that of morphine, and it is worth of being widely promoted and applied in clinical practices. [Key words] Cesarean section; Tramadol; Morphine; Epidural anesthesia; Shivering; Sedation