硬膜外与静脉自控镇痛在剖宫产术后镇痛效果比较及其对母乳喂养的影响

Comparison of analgesic effect between patient-controlled epidural and intravenous analgesia after cesarean section and its influence on breast feeding

目的探讨硬膜外与静脉自控镇痛在剖宫产术后镇痛效果比较及其对母乳喂养的影响。方法选取济南军区总医院于2015年5月至2016年1月收治的108例择期实施剖宫产手术的患者,按照随机数字表法将所有患者随机分为实验组和对照组,每组患者54例。实验组患者均采用硬膜外自控镇痛方式进行术后镇痛,而对照组患者则采用静脉自控镇痛方式进行术后镇痛,观察比较两组患者术后的不良反应发生情况及运动神经阻滞评分(Bromage评分)、24h内的哺乳次数、术后疼痛视觉模拟评分(VAS)、人工喂养添加率等。结果两组患者在48h内各时间点的Bromage评分比较均无统计学意义(t值分别为0.00、0.52、1.22、0.27、0.38、0.54,均P>0.05),而实验组在4h、6h、12h、24h时间点的VAS评分均显著低于对照组(t值分别为4.23、2.89、4.32、18.38,均P<0.05)。实验组患者48h内的哺乳次数为(15.92±9.06),显著高于对照组(11.12±7.13),差异有统计学意义(t=3.76,P<0.01);实验组人工喂养添加率为24.1%,显著低于对照组46.3%,差异有统计学意义(χ~2=9.362,P<0.05)。实验组恶心、呕吐的发生率为3.7%,显著低于对照组18.5%,差异有统计学意义(χ~2=8.728,P<0.05);两组患者的尿潴留发生率和皮肤瘙痒等不良反应发生情况比较差异无统计学意义(χ~2值分别为0.816、0.626,均P>0.05)。结论临床采用硬膜外自控镇痛作为剖宫产术后的镇痛方式比静脉自控镇痛的镇痛效果更好,并且对母乳喂养的影响相对较小。

Objective To discuss and compare the analgesic effect between patient-controlled epidural and intravenous analgesia after cesarean section and its effect on breast feeding. Methods Totally 108 patients scheduled cesarean section in General Hospital of Jinan Military Command during May 2015 to January 2016 were selected. According to the random number table method,all patients were randomly divided into experimental group and control group. There were 54 patients in each group. The patients in the experimental group accepted patient-controlled epidural analgesia,while the patients in control group accepted patient-controlled intravenous analgesia for postoperative analgesia. The incidence of adverse reactions,motor nerve block score（Bromage score）,the times of breast-feeding in 24 h,postoperative visual analogue scale（VAS） and the rate of artificial feeding were observed and compared between two groups. Results There were no significant differences in Bromage scores between two groups at each time point during 48h（t value was 0. 00,0. 52,1. 22,0. 27,0. 38,0. 54,all P〈0. 05）. The VAS scores of patients in experimental group at 4h,6h,12 h,24h were significantly lower than those in control group（t value was 4. 23,2. 89,4. 32,18. 38,all P〈0. 05）. The feeding times of patients in experimental group were 15. 92 ± 9. 06 within 48h,which significantly higher than those in control group,whose feeding times were 11. 12 ± 7. 13. The difference was statistically significant（t = 3. 76,P〈0. 01）. The rate of artificial feeding in the experimental group was 24. 1%,which was significantly lower than that in the control group（46. 3%）. The difference was statistically significant（χ~2= 9. 362,P〈0. 05）. The incidence of nausea and vomiting in the experimental group was 3. 7%,which was significantly lower than that in the control group（18. 5%）. The difference was statistically significant（χ~2= 8. 728,P〈0. 05）. There was no significant difference in the incidences of urinary retention and adverse reactions such as skin itch between two groups（χ~2value was 0. 816,and 0. 626,both P〈0. 05）. Conclusion The analgesic effect of patient-controlled epidural analgesia after cesarean section is better than that of intravenous analgesia and has a relatively small impact on breastfeeding.