硬膜外隙注射舒芬太尼优化剖宫产术后PCIA效果的研究

Study on epidural injection of sufentanil for optimizing PCIA effect after cesarean delivery

目的探讨硬膜外注射舒芬太尼联合静脉自控镇痛(PCIA)用于剖宫产术后镇痛的有效性及安全性。方法将160例足月剖宫产的初产妇分为观察组和对照组各80例。观察组术毕时经硬膜外导管给予0.10μg/kg舒芬太尼,再拔管行PCIA镇痛;对照组术毕后即拔出硬膜外导管行PCIA镇痛。观察两组产妇术后2、6、12、24、48h静息及运动状态下疼痛视觉模拟评分(VAS)、初次泌乳时间,以及术后48h内恶心呕吐等不良反应发生情况。结果两组产妇术后各时间点静息VAS评分比较,差异无统计学意义(P=0.112);观察组术后6、12、24h运动状态VAS评分低于对照组(P<0.01);观察组术后平均初次泌乳时间较对照组早(P<0.01);两组产妇术后48h内恶心呕吐、皮肤瘙痒、呼吸抑制、嗜睡、尿潴留等不良反应发生率比较,差异无统计学意义(P>0.05)。结论剖宫产术后采用硬膜外单次注射舒芬太尼与PCIA联用,可改善PCIA术后镇痛效果,并促进产妇早期泌乳。

Objective To investigate the efficacy and safety of epidual injection of sufentanil combined with patient-controlled intravenous analgesia（PCIA）for analgesia in the parturient after cesarean delivery.Methods A total of 160 full term parturients with cesarean delivery were randomly assigned into the observation group and the control group,80 cases in each group.The observation group was given sufentanil 0.10μg/kg by epidural catheter at the end of cesarean delivery,then removing the epidural catheter and conducting PCIA.The control group conducted PCIA immediately after removing the epidural catheter at the end of cesarean delivery.The pain visual analogue scale（VAS）scores in the resting and motion status at postoperative 2,6,12,24,48 h,first lactation time and occurrence situation of adverse reactions such as nausea and vomiting within postoperative 48 hwere recorded in the two groups.Results The pain VAS scores in resting status at each time point after delivery had no statistical differences between the two groups（P=0.112）;the pain VAS scores in the motion status at postoperative 6,12,24 hin the observation group were lower than those in the control group（P〈0.01）;the first lactation time in the observation group was earlier than that in the control group（P〈0.01）;the incidence rate of adverse reactions within postoperative 48 hsuch as nausea and vomiting,skin itch,respiratory suppression,drowsiness,uroschesis,etc.had no statistical differences between the two groups（P〉0.05）.ConclusionSingle epidural injection of sufentanil combined with PCIA after cesarean delivery could improve the analgesic efficacy of PCIA and promotes early lactation of parturients.