吗啡与地佐辛单次硬膜外腔注射对剖宫产术后硬膜外自控镇痛效果观察

Effects of a single epidural injection of morphine and dezocine on postoperative patient controlled epidural analgesia after cesarean section

目的观察吗啡与地佐辛单次硬膜外腔注射对剖宫产术后硬膜外自控镇痛(PCEA)效果。方法选择2017-01~2019-12该院收治的90例剖宫产产妇,采用随机数字表法将其分为吗啡组、地佐辛组和对照组,每组30例。在手术结束缝合皮肤时,吗啡组、地佐辛组和对照组分别经硬膜外腔注射吗啡2 mg、地佐辛5 mg和生理盐水5 ml,手术结束后均行PCEA。比较三组在术后2 h(T1)、术后4 h(T2)、术后8 h(T3)、术后12 h(T4)、术后24 h(T5)、术后36 h(T6)的视觉模拟量表(VAS)评分。比较三组术后自控按压次数以及恶心呕吐、皮肤瘙痒、头晕、呼吸抑制、下肢感觉和运动异常情况等不良反应的发生情况。结果三组VAS评分均呈先升高再下降的趋势。在T1~T3时间点,对照组的VAS评分均显著高于吗啡组和地佐辛组(P<0.05);而在T2、T3时间点,地佐辛组的VAS评分显著高于吗啡组(P<0.05)。在T4时间点,吗啡组的VAS评分显著低于地佐辛组和对照组(P<0.05)。对照组自控按压次数显著高于吗啡组和地佐辛组(P<0.05),但吗啡组和地佐辛组自控按压次数比较差异无统计学意义(P>0.05)。吗啡组术后有6例(20.00%)发生恶心呕吐,发生率高于地佐辛组(0.00%)和对照组(0.00%),差异有统计学意义(P<0.05);而在皮肤瘙痒、头晕、呼吸抑制、下肢感觉及运动异常等不良反应方面,三组比较差异无统计学意义(P>0.05)。结论单次硬膜外腔注射吗啡和地佐辛均可显著增强剖宫产术后PCEA的效果。地佐辛在镇痛时长及效果方面虽稍弱于吗啡,但安全性更高。

Objective To observe the effects of a single epidural injection of morphine and dezocine on postoperative patient controlled epidural analgesia(PCEA)after cesarean section.Methods Ninety cases of cesarean section women admitted to our hospital from January 2017 to December 2019 were selected and randomly divided into morphine group,dezocine group and control group by the random number table method,with 30 cases in each group.When the skin was sutured at the end of the operation,the morphine group,the dezocine group and the control group were injected with morphine 2 mg,dezocine 5 mg and normal saline 5 ml through the epidural cavity,respectively,and PCEA was performed on the three groups after the operation.The Visual Analogue Scale(VAS)scores were compared among the three groups 2 hours(T1),4 hours(T2),8 hours(T3),12 hours(T4),24 hours(T5)and 36 hours(T6)after the operation.The number of postoperative self-controlled compressions,the occurrence of adverse reactions including nausea,vomiting,skin itching,dizziness,respiratory depression,lower limb sensation and motor abnormalities were compared among the three groups.Results The VAS scores showed an upward trend and then a downward trend in the three groups.At T1,T2 and T3 time points,the VAS scores in the control group were significantly higher than those in the morphine group and the dezocine group(P<0.05),while at T2 and T3 time points,the VAS scores in the dezocine group were significantly higher than those in the morphine group(P<0.05).At T4 time point,the VAS scores in the morphine group were significantly lower than those in the dezocine group and the control group(P<0.05).The number of self-controlled compressions in the control group was significantly higher than that in the morphine group and the dezocine group(P<0.05),but there was no significant difference in the number of self-controlled compressions between the morphine group and the dezocine group(P>0.05).Nausea and vomiting occurred in 6 cases(20.00%)in the morphine group after the operation,and the incidence of nausea and vomiting in the morphine group was significantly higher than that in the dezocine group(0.00%)and the control group(0.00%)(P<0.05).However,there were no significant differences among the three groups in terms of skin itching,dizziness,respiratory depression,lower limb sensation and motor abnormalities,and other adverse reactions(P>0.05).Conclusion A single epidural injection of morphine and dezocine can significantly enhance the effects of PCEA after cesarean section.Although dezocine is slightly weaker than morphine in analgesic duration and analgesic effect,it is safer.