脉冲式硬膜外自控镇痛对剖宫产术后宫缩痛护理的影响

Effect of pulsed epidural analgesia on nursing care of patients with uterine contraction pain after cesarean section

目的观察脉冲式硬膜外自控镇痛对剖宫产术后宫缩痛的镇痛效果及护理干预。方法选取解放军中部战区总医院2019年1—3月择期行剖宫产手术术后均自愿使用硬膜外自控镇痛产妇100例为研究对象,采用随机平行对照试验,将100例研究对象平均分为观察组和对照组,每组50例,对照组采用恒速式硬膜外自控镇痛,观察组采用脉冲式硬膜外自控镇痛,观察2组镇痛效果,同时对2组进行模拟试验,记录背景剂量与追加剂量,2组泵出药液的速度、时间及浸润的面积;记录2组术后6、12、24、48 h切口痛及宫缩痛视觉模拟量表(VAS)评分;记录2组术后当天、术后第1天、术后第2天单次按压后宫缩痛VAS评分,运动阻滞评分;记录2组术后2 d内镇痛泵按压次数、镇痛不全干预次数以及恶心呕吐、皮肤瘙痒、下肢麻木等不良反应发生情况。结果模拟试验显示1、5 min浸润面积观察组和对照组分别为(130.00±14.14)、(334.00±2.83)cm^2和(65.00±7.07)、(137.50±3.54)cm2,差异有统计学意义(t值为5.814、61.376,P<0.05或0.01);观察组术后6、12 h切口痛VAS评分分别为(2.36±1.05)、(2.42±0.95)分,均低于对照组的(3.52±1.09)、(3.16±1.25)分,差异有统计学意义(t值为5.425、3.331,P<0.01);观察组术后6、12、24 h宫缩痛VAS评分分别为(3.92±1.14)、(3.84±1.18)、(2.48±1.05)分,均低于对照组的(4.56±1.42)、(4.34±1.30)、(3.80±1.54)分,差异有统计学意义(t值为2.489、2.008、5.004,P<0.01或0.05);观察组术后当天、术后第1天、术后第2天单次按压后宫缩痛VAS评分分别为(2.66±0.80)、(2.23±0.68)、(2.22±0.71)分,均低于对照组的(5.14±1.05)、(4.48±0.71)、(3.36±0.80)分,差异有统计学意义(t值为13.296、15.536、7.534,P<0.01);观察组术后2 d内镇痛泵按压次数、镇痛不全干预次数分别为(2.28±1.36)、(0.90±0.61)次,均低于对照组的(4.62±1.61)、(0.62±0.53)次,差异有统计学意义(t值为7.847、2.439,P<0.01或0.05);观察组产妇满意度评分(5.92±1.37)分,优于对照组的(2.34±0.82)分,差异有统计学意义(t值为15.856,P<0.01);观察组不良反应如下肢麻木、恶心呕吐、皮肤瘙痒发生率分别为2.00%(1/50)、4.00%(2/50)、4.00%(2/50),均低于对照组的14.00%(7/50)、16.00%(8/50)、18.00%(9/50),差异有统计学意义(χ^2值为4.759、4.000、5.005,P<0.05)。结论脉冲式硬膜外自控镇痛能有效降低剖宫产术后宫缩痛,配合积极的护理干预加快了产妇术后康复,值得在剖宫产术后镇痛中推广。

Objective To observe the analgesic effect and nursing intervention of pulse epidural controlled analgesia on uterine contraction pain after cesarean section.Methods A total of 100 cases of parturient with patient-controlled epidural analgesia after elective cesarean section in Central Theater General Hospital of the Chinese People's Liberation Army from January to March 2019 were selected as study subjects,and 100 cases were divided into observation group and control group,each group of 50 cases,the control group used constant speed epidural patient-controlled analgesia,the observation group used pulse epidural patient-controlled analgesia.The analgesic effect of uterine contraction pain after cesarean section was observed,at the same time,the two groups conducted a simulation test,the speed,time and infiltration area of the pumping liquid were recorded,and the Visual Analogue Scale(VAS)scores of incision pain and uterine contraction pain were recorded at 6 h,12 h,24 h and 48 h postoperatively.VAS score of contraction pain after single press,Motor Block score of iatrogenic uterine pain were recorded on the postoperative day,the first day and the second day after operation.The times of additional dose compression by analgesia pump,the times of incomplete analgesia intervention,nausea and vomiting,skin itching and other adverse reactions were recorded within 2 days after operation.Results The infiltration area at 1,5 min were(130.00±14.14),(334.00±2.83)cm^2 in the observation group and(65.00±7.07),(137.50±3.54)cm^2 in the control group,there were significant differences between the two groups(t values were 5.814,61.376,P<0.05 or 0.01).VAS scores of incision pain at 6 h and 12 h after operation were(2.36±1.05)and(2.42±0.95)in the observation group and(3.52±1.09)and(3.16±1.25)in the control group,respectively,there were significant differences between the two groups(t values were 5.425,3.331,P<0.01).VAS scores of uterine contraction pain at 6,12 and 24 hours after operation were(2.66±0.80),(2.23±0.68),(2.22±0.71)in the observation group and(5.14±1.05),(4.48±0.71),(3.36±0.80)in the control group,respectively,there were significant differences between the two groups(t values were 2.489,2.008,5.004,P<0.01 or 0.05).VAS scores of contraction pain after single press on the postoperative day,the first day and the second day after operation in the observation group were(2.66±0.80),(2.23±0.68),(2.22±0.71)in the observation group and(5.14±1.05),(4.48±0.71),(3.36±0.80)in the control group,respectively,there were significant differences between the two groups(t values were 13.296,15.536,7.534,P<0.01).The times of pressing and intervention were(2.28±1.36)and(0.90±0.61)in the observation group and(4.62±1.61),(0.62±0.53)in the control group,respectively,there were significant differences between the two groups(t values were 7.847,2.439,P<0.01 or 0.05).Maternal satisfaction score was(5.92±1.37)and(2.34±0.82)in the observation group and the control group,there was significant difference(t value was 15.856,P<0.01).The incidence of adverse reactions such as lower limb numbness,nausea and vomiting and skin pruritus in the observation group were 2.00%(1/50),4.00%(2/50)and 4.00%(2/50)respectively,which were lower than those in the control group 14.00%(7/50),16.00%(8/50),18.00%(9/50),the difference was statistically significant(χ^2 values were 4.759,4.000,5.005,P<0.05).Conclusions The pulse epidural controlled analgesia can effectively reduce the uterine contraction pain after cesarean section,and the active nursing intervention can accelerate the postoperative recovery of parturient.