静脉注射氟比洛芬酯和舒芬太尼联合硬膜外吗啡用于剖宫产术后镇痛

Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia

目的评价静脉注射氟比洛芬酯和舒芬太尼联合硬膜外吗啡用于剖宫产术后镇痛的效果和安全性。方法将180例ASA分级Ⅰ-Ⅱ级择期剖宫产初产妇按镇痛泵配方不同分为吗啡组（A组）、舒芬太尼＋吗啡组（B组）和氟比洛芬酯＋舒芬太尼＋吗啡组（C组），每组60例。所有产妇均采用蛛网膜下隙联合硬膜外麻醉，关腹后，三组产妇均硬膜外注入吗啡1．5mg，B组和C组接镇痛泵，舒芬太尼和氟比洛芬酯用0．9％氯化钠稀释到100ml静脉泵注。记录三组术后6，12，24h静息和动态切口痛、宫缩痛的疼痛视觉模拟量表（VAS）评分，镇静程度（Ramsay评分）以及不良反应发生率。结果B组和C组术后6，12，24h静息和动态切口痛及宫缩痛VAS评分均低于A组[静息切口痛：A组分别为（2．6±0．6）、（2．7±0．4）、（2．8±0．3）分，B组分别为（2．3±0．3）、（2．3±0．4）、（2．2±O．3）分，C组分别为（1．8±0．4）、（1．7±0．5）、（1．9±0．4）分；动态切口痛：A组分别为（5．7±0．9）、（5．5±0．8）、（5．6±1．0）分，B组分别为（3．8±0．4）、（3．7±0．5）、（3．7±0．4）分，C组分别为（2．7±0．4）、（2．4±0．5）、（2．4±0．6）分；宫缩痛：A组分别为（5．7±1．2）、（5．9±0．9）、（5．8±1．1）分，B组分别为（3．0±0．5）、（3．1±0．6）、（3．2±0．7）分，C组分别为（2．5±0．5）、（2．5±0．6）、（2．4±0．4）分]，而且C组均低于B组，差异均有统计学意义（P〈0．05）。B组和C组术后6，12，24hRamsay评分高于A组[A组分别为（1．8±0．5）、（1．7±0．4）、（1．9±0．5）分，B组分别为（3．4±0．8）、（3．2±0．7）、（3．3±0．6）分，C组分别为（2．7±0．7）、（2．7±0．5）、（2．6±0．4）分]，而且C组均高于B组，差异均有统计学意义（P〈0．05）。A组和C组不良反应发生率明显低于B组[8．3％（5／60）和23．3％（14／60）比40．0％（24／60）]，而且A组也低于C组，差异均有统计学意义（P〈0．05）。结论氟比洛芬酯与舒芬太尼联合硬膜外吗啡用于剖宫产术后镇痛有协同作用，可以同时缓解产妇切口痛和宫缩痛，效果好且不良反应少。

Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia. Methods One hundred and eighty parturients （ASA I - II ） undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group （group A）,sufentanil ± morphine group （group B ）, flurbiprofen axetil±sufentanil± morphine group （group C） with 60 cases in each group. All patients were used subarachnoid epidural anesthesia, at the end of the surgery, 1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient. Additional, group B and group Creceived patient-controUed intravenous analgesia after cesarean section. Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline. The visual analog scale （VAS） of rest and dynamie ineisional pain and uterine contraction pain, Ramsay sedation scale （RSS）, and adverse events were recorded at 6,12,24 h after operation. Results At 6, 12, 24 h after operation,the VAS scores of rest and dynamic ineisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [ rest ineisional pain： （ 2.6 ± 0.6 ）, （2.7 ± 0.4）, （2.8 ± 0.3 ）scores in group A; （2.3 ± 0.3 ）, （2.3 ± 0.4）, （2.2 ± 0.3 ） scores in group B; （1.8 ±0.4）, （1.7 ±0.5）, （1.9 ±0.4） scores in group C; dynamie ineisional pain： （5.7 ±0.9）, （5.5 ± 0.8 ）, （5.6 ± 1.0） scores in group A ; （ 3.8 ± 0.4）, （ 3.7 ± 0.5 ）, （3.7 ± 0.4） scores in group B; （2.7 ± 0.4 ）, （ 2.4 ± 0.5 ）, （ 2.4 ± 0.6 ） scores in group C ; uterine contraction pain ： （ 5.7 ± 1.2 ）, （ 5.9 ± 0.9 ）, （ 5.8 ± 1.1 ） scores in group A; （3.0 ± 0.5）, （3.1 ± 0.6）, （3.2 ± 0.7）scores in group B; （2.5 ± 0.5）, （2.5 ± 0.6）, （2.4 ± 0.4） scores in group C ], and group C were lower than group B, and there were significant differences （P 〈 0.05）. At 6, 12, 24 h after operation,Ramsay score in group B and group C was higher than that in group A [（1.8 ±0.5）, （1.7 ±0.4）, （1.9 ±0.5） seores in group A; （3.4 ±0.8）, （3.2 ±0.7）, （3.3 ±0.6） scores in group B; （2.7 ±0.7）, （2.7 ±0.5）, （2.6 ± 0.4）scores in group C],and group C was higher than group B, and there were significant differences ±. P 〈 0.05 ）. The ineidenee of adverse events in group A and group C was lower than group B [8.3%（5/60） and 23.3%（14/60） vs. 40.0%（24/60）],and group A was lower than group C, and there were significant differences （P 〈 0.05）. Conclusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative ineisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.