术后镇痛对剖宫产病人胃肠道动力的影响

THE EFFECT OF EPIDURAL ANALGESIA ON THE MOTION OF GASTROINTESTINAL DUCT OF THE PATIENTS UNDERGONE CAESAREAN SECTION

目的 :研究不同药液对剖宫产术后镇痛病人胃肠道动力的影响。方法 :随机选择剖宫产术后硬膜外腔镇痛病人 90例。按术后镇痛所用不同药液随机分为 6组 ,每组 15例 ,测定术毕即刻 ,术毕 6h及 4 8h血浆胃动素 ,同时观察术后 4 8小时内恶心呕吐程度、频率及肛门首次排气时间。结果 :大剂量吗啡组术毕 6h胃动素水平明显高于其他组 (P <0 .0 5 ) ;其他组术后恶心呕吐程度及发生率明显低于大剂量吗啡组 (P <0 .0 5 ) ,加用胃复安两组间相比无明显差别 (C、D组 ) ,但与氟哌啶组 (A、B组 )相比 ,肛门排气时间明显缩短 (P <0 .0 5 )。结论 :吗啡术后镇痛引起消化道并发症可能与促进胃动素的合成及释放增加从而诱导胃体十二指肠不同步运动有关。

Objective: To study the effect of epidural analgesia on the motion of stomach and intestine of the patients undergone caesarean section. Method: Ninety caesarean section patients undergone epidural analgesia were randomly assigned to six groups (n=15 for each group) according to different analgesia solutions, measure their plasma motilin immediately after operation, and then 6 and 48 hours postoperation respectively. The degree and incidence of nausea and vomiting were recorded within 48h, and the first anal exhausting time was also recorded. Results: The motilin level of the patients recieving larger dose morphine groups is significantly higher than those of lower dose morphine ( P <0.05). The degree and incidence of nausea and vomiting are also stronger compared with that of lower doses group. The first anal exhausting time of metoclopramide group (group C and D) is earlier than that in group A and B ( P <0.05). Conclusion: The digestive complications induced by epidural morphine may be related with increased synthesis and secretion of motilin that cause non synchronus movement of stomach and duodenum.