剖宫产术后硬脊膜外腔芬太尼负荷剂量的容积对镇痛的影响

Influence of different volumes of fentanyl as loading dose in epidural cavity on postoperative puerperants' analgesia

目的探讨在蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉(CSEA)下行剖宫产术产妇术后经硬脊膜外腔导管注射相同剂量、不同容量芬太尼对患者自控硬脊膜外腔镇痛(PCEA)效果的影响。方法选择单胎足月妊娠在CSEA下行子宫下段剖宫产术的产妇100例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分入5mL组和1mL组,每组50例。两组在施行PCEA前的麻醉处理相同,在接硬脊膜外腔镇痛泵前经硬脊膜外腔导管注入负荷剂量的芬太尼均为25μg,5mL组的容量为5mL,1mL组的容量为1mL,然后接入配方、容量和注射速度均相同的镇痛泵。在术后1h(T0)、4h(T1)、8h(T2)、12h(T3)、24h(T4)、48h(T5)各时间点,记录疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分。记录产妇术后48h内PCEA有效按压总次数、曲马多用量、不良反应和住院时间,并对镇痛满意度进行综合评价。结果两组间T0时间点的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均>0.05);1mL组T1至T5各时间点的疼痛VAS评分均显著高于5mL组同时间点(P值均<0.05),Ramsay镇静评分均显著低于5mL组同时间点(P值均<0.05)。5mL组产妇的镇痛满意率显著高于1mL组(P<0.05),不满意率显著低于1mL组(P<0.05)。5mL组的PCEA泵按压次数和曲马多用量均显著少于1mL组(P值均<0.05)。5mL组的不良反应发生率显著低于1mL组(P<0.05)。结论硬脊膜外腔注射同样剂量芬太尼作负荷量时,5mL容积优于1mL,有助于提高镇痛效果。

Objective To investigate the effect of pre-filled similar dosage but different volume of fentanyl on patient-controlled epidural analgesia （PCEA） after combined spinal and epidural anesthesia （CSEA） in puerperants. Methods One hundred uterogestation single-birth primiparas, American Society of Anesthesiologists （ASA） grade Ⅰ or Ⅱ, undergoing low-segment cesarean section under CSEA, were randomly divided into two groups （n =50）. Identical fentanyl （25μg with the volume of 5 mL in group A and with the volume of 1 mL in group B） was injected as loading dose before PCEA. The visual analogue scale （VAS） score and Ramsay sedation score at 1 h （T0）, 4 h （T1）, 8 h （T2）, 12 h （T3）, 24 h （T4） and 48 h （T5） were recorded postoperatively. The frequency of pressing bump, tramadol dosage, adverse reaction, hospital stay and analgesia satisfaction were also recorded. Results There was no significant difference in VAS or Ramsay score at To between groups （both P〉0.05）. Compared with those from T1 to T5 in group A, VAS score was significantly increased, while Ramsay sedation score was significantly decreased in group B （all P 〈 0.05）. The rate of puerperants＇ satisfaction for analgesia in group A was significantly higher than that in group B （P〈0.05）. The frequency of pressing bump, tramadol dosage and the incidence of adverse reaction in group A were significantly less than those in group B （all P〈0.05）. Conclusion With the same dosage but different volumes of fentanyl as loading dose on postoperative puerperants＇ analgesia, the analgesia effects of 5 mL is superior to that of 1 mL.