多模式镇痛在基层医院多次剖宫产术后的应用

Application of Multimodal Analgesia after Multiple Cesarean Section in Primary Hospitals

目的:观察吗啡单次硬膜外推注镇痛,适量舒芬太尼和小剂量酒石酸布托啡诺自控静脉镇痛,二者联合应用于基层医院多次剖宫产术后的镇痛效果。方法:选取我院择期行多次剖宫产手术的产妇200例。随机分为试验组和对照组各100例。对照组手术结束后接静脉镇痛泵,而试验组手术结束后连接静脉镇痛泵的同时,硬膜外腔单次推注2 mg吗啡。观察记录产妇在术后2、4、8、12、24 h手术切口疼痛VAS评分及宫缩痛等级评分,并调查产妇对术后镇痛的满意度。记录产妇术后24 h内不良反应的发生情况,如呼吸抑制、恶心呕吐、皮肤瘙痒、嗜睡、血氧饱和度降低等。结果:术后4、8、12、24 h切口疼痛评分,试验组明显优于对照组,差异有统计学意义(P<0.05),两组产妇术后不同时间点子宫收缩疼痛评分比较,试验组均低于对照组,差异有统计学意义(P<0.05),术后镇痛产妇满意度调查显示试验组明显高于对照组(P<0.05);两组产妇术后不良反应的发生情况,差异无统计学意义(P>0.05)。结论:吗啡硬膜外单次注射和适量舒芬太尼复合小剂量酒石酸布托啡诺静脉泵注联合镇痛,应用于多次剖宫产产妇术后疼痛,镇痛效果更佳且不良反应更少,提高了产妇的满意度,为基层医院产妇提供经济满意的术后镇痛方案,值得在基层医院推广应用。

Objective To observe the analgesic effect of single epidural injection of morphine,appropriate amount of sufen⁃tanil and low dose of butorfenol tartrate for patient-controlled intravenous analgesia in the primary hospital after multiple ce⁃sarean section.Methods A total of 200 parturients who underwent elective cesarean section in a primary hospital were se⁃lected.They were randomly divided into experimental group and control group with 100 cases in each group.The control group received an intravenous analgesic pump after the operation,while the experimental group received a single bolus in⁃jection of 2 mg of morphine into the epidural space at the same time as the intravenous analgesic pump was connected after the operation.The VAS score of incision pain and uterine contraction pain at 2,4,8,12 and 24 hours after operation were observed and recorded,and the satisfaction of postoperative analgesia was investigated.Adverse reactions within 24 hours after the operation were recorded,such as respiratory depression,nausea and vomiting,skin itching,drowsiness,and de⁃creased blood oxygen saturation.Results The score of incision pain at 4,8,12 and 24 hours after operation in experimental group was significantly better than that in control group and the difference was statistically significant(P<0.05).The pain scores of uterine contractions in the experimental group were lower than those in the control group at different time points af⁃ter maternity operation,and the differences were statistically significant(P<0.05).The satisfaction of puerpera with postop⁃erative analgesia was significantly higher in experimental group than in control group(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion A single epi⁃dural injection of morphine and a moderate amount of sufentanil combined with a small dose of butorphanol tartaric acid in⁃travenous pump for analgesia were applied to the pain after multiple caesarean section.The analgesia effect is better and the adverse reactions are less,which improves the satisfaction of the puerpera,and provides an economically satisfactory post⁃operative analgesia program for the puerpera in primary hospitals,which is worth popularizing in primary hospitals.