两种椎管内麻醉剖宫产术后PCEA镇痛效果比较  

Postoperative analgesia efficacy of PCEA during spinal anesthesia and epidural anesthesia for cesarean section

作　　者：宋恺颖[1] 谭宪湖[1] 

机构地区：[1]广西医科大学第一附属医院麻醉科,广西南宁530021

出　　处：《蛇志》2012年第4期352-353,355,共3页Journal of Snake

基　　金：广西壮族自治区卫生厅自筹经费科研课题(编号:Z2011353)

摘　　要：目的比较两种不同麻醉方式剖宫产术后应用PCEA的影响。方法选择拟行剖宫产产妇80例,ASAⅠ～Ⅱ级,随机分为腰麻组40例,硬膜外麻醉组40例,两组均输入羟乙基淀粉130/0.4氯化钠溶液10ml/kg(共同负荷),分别采用腰麻、硬膜外麻醉两种麻醉方式行剖宫产,两组产妇术后均连接相同配方PCEA,并观察术后镇痛效果,恶心呕吐、瘙痒、腰痛等不良反应;观察下肢运动神经阻滞情况、下床时间、肠排气时间、开始泌乳时间等术后恢复情况。观察时间点为术后2、4、8、12、24、48、72h。结果两组术后应用PCEA比较,腰麻组静息VAS疼痛评分T1时点腰麻组高于硬膜外麻醉组(P<0.05),T2、T3时点腰麻组低于硬膜外麻醉组(P<0.05);活动VAS评分T1时点腰麻组高于硬膜外麻醉组,T2、T3、T4时点腰麻组低于硬膜外麻醉组(P<0.05);腰麻组较硬膜外麻醉组产妇的肠排气时间和泌乳时间短(P<0.05),瘙痒发生率高(P<0.05),腰痛发生率低。结论在剖宫产手术中,相对硬膜外麻醉而言,腰麻能使PCEA产生更好的镇痛效果,术后产妇运动功能恢复快,无其它严重不良反应,且利于肠蠕动功能恢复和泌乳。Objective To explore the different of postoperative analgesia efficacy of PCEA for cesarean section on spinal anesthesia and epidural anesthesia. Methods Eighty cases cesarean section（ASA Ⅰto Ⅱ ） were random- ly divided into tow groups with 40 cases each., spinal anesthesia group and epidural anesthesia group. Respectively using spinal anesthesia and epidural anesthesia for cesarean section,connected PCEA on postoperation with same recipe. Efficacy of postoperative analgesia, untoward effect,and the time of intestinal exhaust, out-of-bed activity, lactation were recorded on 2,4,8,12,24,48,72 hours. Results The quiescence VAS score in spinal anesthesia group was significantly higher than epidural anesthesia on T, （P〈0. 05） and significantly lower than epidural anes- thesia on T2 ,T3 （P〈0.05）. The activity VAS score in spinal anesthesia group was significantly higher than epi- dural anesthesia on T, （P〈0.05） and significantly lower than epidural anesthesia on T2 ,T3 ,T4 （P〈0.05）. The time of intestinal exhaust and lactation in spinal anesthesia group were significantly shorter than epidural anesthesia group（P〈0.05）. The incidence of pruritus and backache in spinal anesthesia group was higher than epidural anes- thesia（P〈0.05）. Conclusion Better postoperative analgesia efficacy of PCEA was on the spinal anesthesia ＇for cesarean section. There was more benefit for spinal anesthesia for cesarean with PCEA to postoperative activity,in- testinal exhaust and lactation.

关 键 词：腰麻 硬膜外麻醉 剖宫产 PCEA 

分 类 号：R713.42[医药卫生—妇产科学]