不同镇痛方法对剖宫产术后镇痛效果的影响

Evaluation of different methods of analgesia on maternal after cesarean section

目的:观察不同镇痛方法对剖宫产术后产妇的镇痛效果,评价其安全性、有效性及经济成本。方法:180例我院拟行剖宫产手术的初产妇,随机分为6组(n=30),采用患者自控硬膜外镇痛(PCEA)或自控静脉镇痛(PCIA)。1PCEA-RS组:0.2%罗哌卡因复合舒芬太尼0.5μg/ml,2PCEA-RT组:0.2%罗哌卡因复合曲马多8 mg/ml,3PCEA-RF组:0.2%罗哌卡因复合芬太尼5μg/ml,4PCIA-S组:舒芬太尼0.5μg/ml,5PCIA-T组:曲马多8 mg/ml+格拉斯琼3 mg,6PCIA-F组:芬太尼5μg/ml。注射速度2 ml/h,PCA量0.5 ml,锁定时间15 min,观察并记录患者术后的疼痛评分、恶心呕吐、肢体麻木、尿潴留等不良反应。结果:各组产妇在术后各时段的VAS评分、满意度、PCA次数上相比差异无统计学意义(P>0.05);PCEA组镇痛成本明显高于PCIA组(P<0.05);PCEA组产妇肢体麻木明显多于PCIA组。结论:硬膜外和静脉自控镇痛都可有效缓解剖宫产术后产妇伤口疼痛,静脉镇痛更利于产妇活动,照顾婴儿,极少有镇痛泵意外脱落,有较高的满意度,且成本低。

Objective To compare the effect of different methods of analgesia on maternal after cesarean section,and to evaluate the safety,effectiveness and economic costs. Method 180 primiparaes undergoing cesarean section in our hospital were randomly divided into six groups（n=30）,patient-controlled epidural analgesia（PCEA）or intravenous analgesia（PCIA）was performed in each group as fol-lows.① PCEA-RS group ：combination of 0. 2% ropivacaine and sufentanil 0. 5 μg/ml,② PCEA-RT group ：combination of 0. 2%ropivacaine and tramadol 8 mg/ml,③ PCEA-RF group ：combination of 0. 2% ropivacaine and fentanyl 5μg/ml,④PCIA-S group：sufentanil 0. 5μg/ml,⑤PCIA-T group：combination of tramadol 8 mg/ml and granisetron 3 mg,⑥ PCIA- F group：fentanyl 5 μg/ml. The flow rate was 2 ml / h,the PCA volume was 0. 5 ml,the lockout time was 15 min. To observe and record postoperative pain scores, nausea,vomiting,numbness,urinary retention and other adverse reactions. Results There were no significant difference on the patients＆#39; VAS 〈br〉 score,satisfaction,PCA times among the groups（P﹥0. 05）;the cost and incidence of leg numbness in PCEA groups were significantly high-er than that of the PCIA groups（P﹤0. 05）. The fart time in PCEA groups was shorter than that of the PCIA groups（P﹤0. 05）. Conclusion Both PCIA and PCEA can effective analgesia after cesarean section for patients. The PCIA is more conducive to maternal activities,taking care of the baby,and has less accidental removal of analgesia apparatus,lower cost and higher satisfaction.