硫酸镁对子痫前期重度产妇剖宫产术后镇痛效果的影响

Influence of magnesium sulfate on analgesia effect after cesarean section for puerpera with severe pre-eclampsia

目的观察静脉输注硫酸镁对子痫前期重度产妇剖宫产术后镇痛效果的影响。方法选择本院2013年1月-2014年12月收治的子痫前期重度行剖宫产的产妇200例,将其随机分为观察组和对照组,每组100例。观察组围术期使用硫酸镁〉2 d,每日用量〉15 g,而对照组产妇则不使用硫酸镁。两组均在鞘内注入1%罗哌卡因1.0-1.2 ml行腰-硬联合麻醉,待胎儿取出缝合腹膜后,在硬膜外腔给予吗啡2.0 mg,然后接PCA镇痛泵,泵内药液为0.125%盐酸罗哌卡因和0.000 04%吗啡（含吗啡4 mg）共计100 ml,负荷量为5 ml,背景剂量2 ml/h,单次给药剂量（bolus）为1.0 ml,锁定时间为15 min。观察两组的术后镇痛效果、产妇舒适度,并观察恶心呕吐、皮肤瘙痒及尿潴留的发生率;观察血镁与皮质醇的变化。结果观察组产妇的镇痛效果和舒适度均显著优于对照组（P〈0.01）,而恶心呕吐、皮肤瘙痒及尿潴留的发生率也低于对照组（P〈0.05）。在一定范围内,血镁的浓度与患者的疼痛程度成反比关系。结论静脉输注硫酸镁可减轻子痫前期重度产妇的术后疼痛,降低其恶心呕吐、皮肤瘙痒及尿潴留的发生率,提高产妇的舒适度。

Objective To observe the influence of intravenous infusion of magnesium sulfate on analgesia effect after cesarean section for puerpera with severe pre-eclampsia. Methods 200 puerperae with severe pre-eclampsia given ce-sarean section treated in our hospital from January 2013 to December 2014 were selected,and they were randomly di-vided into observation group （n=100） and control group（n=100）.Observation group was given magnesium sulfate for more than 2 days,daliy dose was more than 15 g,while control group was not given magnesium sulfate.Both groups were given intrathecal injection 1% ropivacaine of 1.0-1.2 ml for combined spinal-epidural anesthesia. After the fetal disengage-ment and the peritoneum was sutured,2.0 mg morphine was infused in the epidural space,then PCA analgesia pump was connected,and the liquid in the pump was 0.125% ropivacaine and morphine 0.000 04% （containing morphine 4 mg） coming to 100 ml,the load quantity was 5 ml, background dose was 2 ml/h,single dose of medicament （bolus） was 1 ml, the lock time was 15 min.Analgesic effect after operation and comfort degree of puerpera,and the incidence rate of nau-sea and vomiting, skin pruritus and urinary retention,change of blood magnesium and cortisol in two groups was com-pared respectively. Results The analgesic effect and comfort degree of observation group was significantly better than that of the control group respaetively （P〈0.01）,while the incidence rate of nausea and vomiting,skin pruritus and urinary retention was also lower than that of control group （P〈0.05）.In a certain range,the concentration of serum magnesium was inversely proportional to the pain degree of the patients. Conclusion Intravenous infusion of magnesium sulfate can relieve the postoperative pain and reduce the incidence rate of nausea and vomitting,skin pruritus and urinary reten-tion,and improve the comfort degree of puerpera.