联合口服对乙酰氨基酚、塞来昔布、曲马多实施剖宫产术后镇痛的临床研究

Orally taking paracetamol, celecoxib, and tramadol for analgesia after cesarean section

目的比较在腰硬联合麻醉下行剖宫产术后，联合口服对乙酰氨基酚、塞来昔布、曲马多缓释片镇痛方法与硬膜外自控镇痛及吗啡静脉自控镇痛的镇痛效果及副作用。方法永州市中心医院择期腰硬联合麻醉行剖宫产术的产妇150例，随机分为联合口服药物镇痛组、硬膜外自控镇痛组、吗啡静脉自控镇痛组（每组50例）。联合口服药物镇痛组术后口服对乙酰氨基酚片、塞来昔布胶囊、曲马多缓释片（Oral组），硬膜外自控镇痛组术后采用硬膜外镇痛泵镇痛（PCEA组），吗啡静脉自控镇痛组术后采用患者自控静脉镇痛泵镇痛（PCIA组）。采用视觉模拟评分法（VAS评分）记录术后3d内静息、活动、按摩子宫时的疼痛评分，记录下床活动开始时间、镇痛相关副作用、住院天数、产妇满意度和与镇痛相关的费用。结果术后第1天在静息、活动、按摩子宫时Oral组的VAS评分与PCEA组比较差异无统计学意义（P〉0．05），Oral组和PCEA组VAS评分均较PCIA组低（均P〈0．05）；术后第2天Oral组的VAS评分与PCEA组比较差异无统计学意义（P〉0．05），Oral组和PCEA组VAS评分均较PCIA组低（均P〈0．05）；术后第3天的VAS评分，3组比较差异均无统计学意义（均P〉0．05）。Oral组镇痛相关副作用发生例数均低于PCEA组和PCIA组（均P〈0．05）。Oral组术后开始下床活动时间比PCEA组和PCIA组要早（均P〈0．05）。Oral组产妇的满意度评分均高于PCEA组和PCIA组（均P〈0．05）。结论腰硬联合麻醉下剖宫产术后联合口服对乙酰氨基酚片、塞来昔布胶囊、曲马多缓释片镇痛效果与硬膜外自控镇痛相当，且优于吗啡PCIA，联合口服镇痛药物组早期下床活动时间提前，镇痛相关副作用、费用低且产妇满意度高。

Objective To explore the analgesic effects and side effects of compare the of orally taking paracetamol, celecoxib, and tramadol for analgesia versus patient-controlled epidural analgesia versus patientcontrolled intravenous analgesia with morphine after cesarean section under combined spinal-epidural anesthesia. Methods One hundred and fifty women undergoing cesarean section under elective combined spinal-epidural anesthesia at Yongzhou Central Hospital were randomly divided into an oral group, a PCEA group and a PCIA group, 50 for each group. The oral group orally took paracetamol, celecoxib capsules, tramadol extended-release tablets for analgesia, the PCEA group took analgesia with patient-controlled epidural analgesia pump, and the PCIA group took analgesia with patient-controlled intravenous analgesia pump with morphine. The visual analogue scale （ VAS score ） was used to record pain scores during rest, activity, and the massage of the uterus within 3 days after operation. The time for off-bed activity, analgesia-related side effects, hospital stay, maternal satisfaction, and analgesia cost were recorded. Results During rest, activity, and the massage of the uterus 1 and 2 days after operation, there were no statistical differences in the VAS scores between the oral group and the PCEA group （ P〉 0.05 ） ; and the VAS scores of the oral group and the PCEA group were lower than those of the PCIA group （ P 〈0.05 ） . 3 days after operation, there were no statistical differences in the VAS scores among these groups （ P〉 0.05 ） . Fewer patients occurred analgesia-associated adverse events, the time for offbed activity was shorter, and the score of satisfaction was higher in the oral group than in the PCEA group and the PCIA group （P 〈0.05 ） . Conelnsions Orally taking paracetamol, celecoxib, and tramadol for analgesia after cesarean section under combined spinal-epidural anesthesia is as effective as patient-controlled epidural analgesia and more effective than patient-controlled intravenous analgesia with morphine, can take off-bed activity earlier, and has lower incidence of analgesia-associated adverse events and cost and higher maternal satisfaction.