术后不同静脉镇痛方法对剖宫产术后疼痛的影响

The Effect of Different Postoperative Intravenous Analgesia on the postoperative pain of Cesarean Section Patients

目的观察右旋美托咪啶辅助芬太尼用于剖宫产术后病人自控静脉镇痛(PCIA)的效果。方法择期脊椎-硬膜外麻醉下行剖宫产术病人60例,将病人随机分为两组(n=30):F组为芬太尼镇痛组:芬太尼15μg/kg+昂丹司琼8mg;D组为右旋美托咪啶组:右旋美托咪啶(批号10061434,江苏恒瑞医药)200μg+芬太尼15μg/kg+昂丹司琼8 mg,镇痛泵额定容量200 m L,背景量4.0 m L/h,bolus 0.5 m L,锁定时间15 min。观察两组剖宫产手术后1、2、4、8、24、48 h的疼痛视觉模拟评分(VAS);Ramsay镇静评分;患者自控镇痛按压次数;术后24 h时评价病人满意度及不良反应情况。结果剖宫产手术后的4、8、24 h的VAS评分,D组明显低于F组;而4、8、24 h的Ramsay镇静评分D组明显高于F组;手术后镇痛的综合满意度D组高于F组;手术后的瘙痒、恶心、呕吐发生率D组明显少于F组。D组、F组中的1 h的VAS评分与同组其他时间点比较低,有差异性;而Ramsay镇静评分与同组其他时间点比较则高,有差异性。其余两组各指标之间无统计学差异。结论右旋美托咪啶辅助芬太尼用于剖宫产术后PCIA的效果优于单独应用芬太尼,同时可以减少手术后的不良反应。

Objective To investigate the effect of different postoperative intravenous analgesia on the postoperative pain of cesare- an section patients. Methods 60 cases of cesarean section patients using spinal and epidural anesthesia were chosen. After operation, the patients were randomly divided into two groups （n = 30） ： Group F （the fentanyl group, fentanyl 15 μg/kg ＋ ondansetron 8mg） and Group D （ the dexmedetomidine group, Dexmedetomidine 200 μg ＋ fentanyl 15 μg/kg ＋ ondansetron 8 rag）. The analgesia pump capacity was 200 mL, background 4. 0 mL/h, 0. 5 mL bolus and locking time was 15 minutes. 1, 2, 4, 8 , 24 and 48 h after oper- ation, the pain visual analog scale （VAS） , Ramsay score, sedation score were recorded, and observation was made of the patient satisfaction and adverse reaction during 24 h. Results The values of VAS on 4 , 8 h and 24 h were low in group D compared with those of group F. The ramsay scores were higher in group D than those in group F on 4, 8 h and 24 h. The adverse reaction was lower in group D than that of group F. Conclusion Dexmedetomidine and fentanyl for cesarean section postoperative PCIA was better than that of using fentanyl alone. At the same time, it can reduce the adverse reaction after operation.