吗啡鞘内和硬膜外注射用于剖宫产手术后镇痛的效果比较  

Intrathecal Versus Epidural Morphine For Postoperative Analgesia After Cesareansection

作　　者：齐晓非[1] 崔睿[1] 文亚杰[1] 李元涛[1] 吴铭广[1] 

机构地区：[1]南方医科大学附属深圳妇幼保健院麻醉科,深圳518028

出　　处：《医药导报》2013年第6期715-718,共4页Herald of Medicine

基　　金：2010年深圳市科技计划项目(201003101)

摘　　要：目的比较鞘内和硬膜外注射吗啡用于剖宫产手术后镇痛的效果及不良反应。方法剖宫产患者200例,随机分为鞘内注射吗啡组(IM组)和硬膜外注射吗啡组(EM组),每组100例。均行腰硬联合阻滞,IM组蛛网膜下腔用药为含吗啡0.1 mg的0.5%罗哌卡因12～15 mg;EM组蛛网膜下腔用药为不含吗啡的0.5%罗哌卡因12～15 mg。术毕IM组直接拔出硬膜外导管,EM组硬膜外腔注射吗啡2 mg后拔出硬膜外导管,两组均使用曲马多静脉镇痛泵。观察两组患者手术后12,24,48 h静态和动态疼痛视觉模拟评分(VAS),恶心呕吐、瘙痒、头晕、呼吸抑制、嗜睡、尿潴留以及神经系统并发症的发生情况。结果 IM组与EM组手术后24 h动态VAS评分分别是2.92±1.80和3.93±2.23,差异有统计学意义(P<0.01)。手术后24 h静态评分、手术后12和48 h疼痛评分两组均差异无统计学意义(P>0.05)。两组恶心呕吐、瘙痒、头晕、呼吸抑制、嗜睡、尿潴留和神经系统并发症发生率相似(P>0.05)。结论鞘内与硬膜外吗啡镇痛在安静状态下镇痛效果相似,手术后24 h活动状态时鞘内镇痛效果好于硬膜外镇痛。鞘内注射吗啡镇痛是剖宫产手术后镇痛的良好选择之一。Objective To study the efficacy and safety of postoperative analgesia in parturients for elective cesarean- section using morphine intrathecally or epidurally. Methods Two hundred parturients undergoing elective cesarean-section were devided into two groups： intrathecal morphine （IM） group and epidural morphine （EM） group. Each group contained 100 parturients. All the parturients received combined spinal and epidural anesthesia. IM group received injection of 0.5% ropivacaine 12-15 mg containing 0.1 mg morphine intratheeally, and the epidural catheter was removed immediately after operation. EM group received injection of intrathecal 0.5% ropivacaine 12-15 mg wihout morphine. Two miligrams of morphine was given into the epidural space before the epidural catheter was removed. Both groups received intravenous tramadol analgesia pump. During the fist 12, 24 and 48 h after operation, static and dynamic pain visual analogue score （VAS） , rate of nausea and vomiting, pruritus, drowsiness, breath inhibition, urinary retention and nervous complications were observed. Results Twenty-four hours after operation, dynamic pain VAS was significantly different between the IM and EM groups （2.92±1.80 vs. 3.93±2. 23, P〈0.01 ）. Static VAS at 24 h postoperation and VAS at 12 and 48 h postoperation were similar between the two groups （P〉 0.05 ）. Incidence rates of complications such as nausea and vomiting, pruritus, drowsiness, breath inhibition, urinary retention and nervous complications were similar between the two groups （ P〉0.05 ）. Conclusion Intrathecal and epidural morphine produced the same .level of analgesia at rest state, while IM exerted better analgesia effect than EM at dynamic state 24 h after operation. Intrathecal morphine is one of good options for postoperative analgesia in parturients.

关 键 词：吗啡 注射 鞘内 注射 硬膜外 镇痛 剖宫产 

分 类 号：R971.2[医药卫生—药品] R714.4[医药卫生—药学]