吸氧对椎管内麻醉下剖宫产术后疼痛的影响

Effect of High Inspired Oxygen on the Postoperative Pain of Casarean Section under Spinal Anaesthesia

目的:评价麻醉前和术中持续吸氧对椎管内麻醉下剖宫产术后疼痛的效果。方法:选择ASAI-II级择期行剖宫产手术的初产妇100例,将其随机分为面罩吸氧组和空气吸入组(对照组)。吸氧组于术前30 min及术中通过面罩全程给氧,吸入氧浓度为60%,空气组则不给予特殊处理。检测和比较两组产妇不同时点的心率、血压及SpO2的变化,手术时间,视觉模拟评分(VAS),新生儿Apgar评分,胎儿氧饱和度,新生儿脐动静脉血气,产妇血气以及术后24 h内恶心呕吐的发生率。结果:两组产妇各时间点心率、血压、SpO2、手术时间及新生儿Apgar评分、胎儿氧饱和度比较均无显著性差异(P>0.05)。吸氧组术后6 h、12 h、24 h的VAS评分分别为(4.07±0.10)、(2.13±0.12)和(0.42±0.08),均明显低于对照组的(6.10±0.11)、(4.02±0.13)及(1.10±0.22)(P<0.05)。吸氧组新生儿脐动静脉血气、产妇血气氧分压均显著高于对照组(P<0.05),术后24h内恶心呕吐的发生率显著低于对照组(P<0.05)。结论:麻醉前和术中持续吸氧能显著减轻椎管内麻醉下剖宫产术后疼痛,同时有效降低术后恶心呕吐的发生率。

Objective： This study aimed to evaluate the effect of preoperative and intraoperaative high oxygen inhalation on the postoperative pain of casarean section under spinal aneshhesia. Methods： 100 primiparaes with ASAI-II undergoing elective caesarean operation were selected and randomly assigned to two groups（50 cases in each group）. The primiparaes of oxygen inhalation group inspired oxygen 30 min preoperation and intraoperation through mask, and the oxygen concentration was 60%; while the primiparaes of control group inhaled air only. The heart rate, blood pressure, change of SpO2, operation time, visual analogue scale（VAS）, Apgar score of neonates, fetal oxygen saturation, umbilical artery and venous blood gas, maternal blood gas at different time points and the incidence of postoperative nausea and vomiting in 24 h were detected and compared between the two groups. Results： No significant difference was found in the heart rate, blood pressure, SpO2, operation time, Apgar score of neonates and fetal oxygen saturation at different time points between the two groups（P〉0.05）. The VAS scores of oxygen inhalation group 6, 12 and 24 h postoperation were respectively（4.07±0.10）,（2.13±0.12） and（0.42±0.08）, which were all significantly lower than those of control group（（6.10±0.11）,（4.02±0.13）,（1.10±0.22）, P〈0.05）. Compared with the control group, the umbilical artery and venous blood oxygen pressure, maternal blood oxygen pressure were all markedly higher（P〈0.05）, the incidence of postoperative nausea and vomiting in the 24 h was significantly lower（P〈0.05）. Conclusion： Preoperative and intraoperative continuous oxygen inhalation could significantly reduce the postoperative pain of casarean section under spinal anaesthesia cesarean, and effectively decrease the incidence of postoperative nausea and vomiting.