鞘内注射小剂量吗啡辅以穴位贴敷在剖宫产术后镇痛的临床研究  

Effect of intrathecal morphine injection with acupoint application on postoperative analgesia of cesarean section

作　　者：张勇[1] 

机构地区：[1]广州中医药大学祈福医院麻醉科,广东广州511495

出　　处：《中国误诊学杂志》2012年第14期3528-3530,共3页Chinese Journal of Misdiagnostics

摘　　要：目的探讨鞘内注射小剂量吗啡对产妇的术后镇痛效果的影响及吗啡用于鞘内注射的最佳剂量，并观察穴位贴敷三阴交穴对其镇痛效果的影响。方法选择ASAⅠ～Ⅱ级足月妊娠产妇180例行剖宫产手术，随机分成6组（各30例）实施腰硬联合麻醉（CSEA）。对照组（A组）用0．5％的布比卡因2．0ml（10．0mg）＋50％葡萄糖溶液0．2ml，B、C、D、E组为吗啡处理组，分别在对照组基础上加用吗啡0．1、0．3、0．6和0．9mg，F组在C组基础上使用穴位贴敷方法。评价新生儿情况、术后VAS评分及围术期不良反应。结果各组新生儿1min和5min时Apgar评分在正常范围（P〉0．05）。与对照组比较，鞘内加人吗啡可使术后无痛时限明显延长（P〈0．05）。术后各吗啡组恶心呕吐及皮肤瘙痒与剂量相关，D组和E组病例的恶心呕吐、皮肤瘙痒发生率明显高于对照组（P〈0．05）。F组与C组相比镇痛效果显著（P〈0．05），能减少吗啡的使用量，并能显著减少使用吗啡后的恶心呕吐、皮肤瘙痒等不良反应发生率（P〈0．05）。结论吗啡鞘内注射能有效延长剖宫产术后镇痛时间，对新生儿无影响，具有良好的安全性。白芥子膏三阴交敷贴能减少吗啡的使用量，同样能达到镇痛效果，并能显著减少使用吗啡后的恶心呕吐、皮肤瘙痒等不良反应发生率。Objective To observe the optimal dosage and rne elleCt ut ,xttaL＊,~,~a＊ ,＊.v.v -J ~ - . plication on postoperative analgesia of cesarean section. Methods 180 full-term pregnancy parturient with ASA grade Ⅰ to Ⅱ who would be performed cesarean section were chosen. They were randomly allocated into 6 groups （each group including 30 patients were given lumbar anesthesia）. Group A （control group） was given 2.0 ml Bupivacaine（10.0 mg） and 0.2 ml 50 Glucose. Morphine group B, C, D, E were given morphine of 0.1 mg, 0, 3 rag, 0.6 rag, 0.9 mg respectively on the base of group A）. Group F was performed acupoint application based on group C. After that, condition of newborns, analgesia after operation according VAS and adverse effects were investiga- ted. Results 1-minute and 5-minute apgar scores of newborns in each group were within normal range （P〈0.05） The time of effective analgesia after operation in morphine groups was significantly longer than group A （P〈0.05）. Cutaneous pruritus, nausea and vomiting are related with dosage. The incidence of cutaneous pruritus, nausea and vomiting in group D and E was significantly higher than group A （P〈0.05）. Group F which use less morphine and had lower incidence of adverse effect such as cutaneous pruritus, nausea and vomiting （P〈0.05） had better analgesia effect than group C （P〈0.05）. Conclusion Morphine could be safely used in cesarean section and had no effects on newborns, and 0.3 mg morphine is the optimal dosage of intratheeal injection for postoperative analgesia. With white mustard seed acupoint sticking, pregnant woman can reduce dosage of morphine, and can significantly reduce incidence of reverse efiect such as nausea, vomiting and cutaneous pruritus.

关 键 词：注射 脊髓 吗啡/投药和剂量 穴位贴敷法 剖宫产术 疼痛 手术后/药物疗法 镇痛 

分 类 号：R719.8[医药卫生—妇产科学]