不同药物配伍用于剖宫产术后镇痛的临床分析

Clinical Analysis of Different Drug Compatibility for Analgesia after Cesarean Section

目的探讨右旋美托咪啶,酮咯酸辅助舒芬太尼用于剖宫产术后患者自控静脉镇痛(PCIA)的效果。方法方便选择该院2016年5月—2017年5月联合椎管内麻醉下行剖宫产术的产妇90例,将患者随机分为3组(n=30):K组为酮咯酸镇痛组:应用氨丁三醇酮咯酸90 mg+舒芬太尼1μg/kg+昂丹司琼8 mg;D组为右旋美托咪啶组:应用右旋美托咪啶200μg+舒芬太尼1μg/kg+昂丹司琼8 mg;F组应用酮咯酸氨丁三醇90 mg+右旋美托咪啶200μg+舒芬太尼1μg/kg+昂丹司琼8 mg。镇痛泵额定容量100 m L,背景量2.0 m L/h,bolus 2.0 m L,锁定时间10 min。观察3组剖宫产手术后6、12、24、48 h的疼痛视觉模拟评分(VAS);Ramsay镇静评分;术后48 h时评价患者满意度及不良反应情况。结果 3组术后收缩压(114±10)mm Hg vs(122±9)mm Hg,(116±12)mm Hg vs(127±13)mm Hg,(113±11)mm Hg vs(127±8)mm Hg;心率(80±14)次/min vs(90±16)次/min,(77±9)次/min vs(94±16)次/min,(76±7)次/min vs(88±8)次/min,均明显低于术前(t=4.587,5.248,4.875,4.214,3.983,4.125,P<0.05)。F组术后各时点的VSA评分均明显低于K组和D组(0.55±0.60)分vs(1.58±0.63)分,(0.55±0.60)分vs(1.56±0.48)分,(0.55±0.76)分vs(2.00±1.03)分,(0.55±0.76)分vs(1.68±1.06)分,(0.75±0.58)分vs(1.65±1.27)分,(0.75±0.58)分vs(1.58±0.78)分,(0.00±0.00)分vs(1.52±0.47)分,(0.00±0.00)分vs(1.65±0.58)分,(t=6.255,6.175,6.305,6.278,3.868,4.081,16.551,16.87 6,P<0.05),效果F组优于K组和D组;而24 h的Ramsay镇静评分均为2分,安静合作,3组差异无统计学意义;手术后镇痛的综合满意度F组高于K组(χ2=3.490 9,P<0.05);手术后恶心、呕吐发生率K组明显高于F组和D组(8例vs 2例)(8例vs 1例)(χ2=4.32,4.705 8,P<0.05)。结论F组氨丁三醇酮咯酸90 mg+右旋美托咪啶200μg+舒芬太尼1μg/kg+昂丹司琼8 mg,镇痛泵额定容量100 m L,背景量2.0 m L/h,bolus 2.0 m L,锁定时间10 min,明显优于K组和D组,可以安全有效地用于剖宫产术后的镇痛。

Objective This paper tries to discuss the effect of dexmedetomidine and ketorolac supplemented with sufentanil for patient-controlled intravenous analgesia(PCIA)after cesarean section.Methods 90 cases in this hospital from May 2016 to May 2017 of combined spinal anesthesia with cesarean delivery were conveniently selected,the patients were randomly divided into three groups(n=30):group K was ketorolac analgesic group:trometamol ketorolac 90 mg+sufentanil 1μg/kg+ondansetron 8 mg;group D was dexmedetomidine group:dexmedetomidine 200μg+sufentanil 1μg/kg+ondansetron 8 mg;group F was ketorolac tromethamine 90 mg+dexmedetomidine 200μg+sufentanil 1μg/kg+ondansetron 8mg.Analgesia pump rated capump rated capacity of 100 mL,background volume of 2.0 mL/h,bolus 2.0 mL,locking time 10 min.Visual acuity scores(VAS)at 6,12,24 and 48 h after cesarean section were observed in the three groups.The sedation score of Ramsay was evaluated.Patient satisfaction and adverse reactions were evaluated at 48 h after operation.Results The postoperative systolic blood pressure(114±10)mmHg vs(122±9)mmHg,(116±12)mmHg vs(127±13)mmHg,(113±11)mmHg vs(127±8)mmHg,heart rate(80±14)times/min vs(90±16)times/min,(77±9)times/min vs(94±16)times/min,(76±7)times/min vs(88±8)times/min,were significantly lower than preoperative(t=4.587,5.248,4.875,4.214,3.983,4.125,P<0.05).The VSA scores of group F were significantly lower than those of group K and group D of(0.55±0.60)points vs(1.58±0.63)points,(0.55±0.60)points vs(1.56±0.48)points,(0.55±0.76)points vs(2.00±1.03)points,(0.55±0.76)points vs(1.68±1.06)points,(0.75±0.58)points vs(1.65±1.27)points,(0.75±0.58)points vs(1.58±0.78)points,(0.00±0.00)points vs(1.52±0.47)points,(0.00±0.00)points vs(1.65±0.58)points,(t=6.255,6.175,6.305,6.278,3.868,4.081,16.551,16.876,P<0.05),the effect of group F was better than group K and D;and 24 h of Ramsay sedation scores were 2 points,(P<0.05).The incidence of nausea and vomiting in operation group K was significantly higher than that in group F(P<0.05).There was no significant difference between the three groups And group D(8 cases vs 2 cases)(8 cases vs 1 cases)(χ2=4.32,4.705 8,P<0.05).Conclusion Group F trometamol ketorolac 90 mg+dexmedetomidine 200μg+sufentanil 1 ug/kg+ondansetron 8 mg,analgesic pump rated capacity 100 mL,the amount of background 2.0 mL/h,bolus 2.0 mL,lock time 10 min,significantly better than the group K and group D,can be safely and effectively used for analgesia after cesarean section.