硬膜外注射吗啡用于缓解侧切产妇产后会阴部疼痛的效果  

Efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy

作　　者：毛毛[1] 王朝晖[1] 冯善武[1] 徐世琴[1] 沈晓凤[1] 王娴[1] MAO Mao WANG Zhaohui FENG Shanwu XU Shiqin SHEN Xiaofeng WANG Xian .(Department of Anesthesiology, Obstetrics and Gynecology Hospital Affiliated to Nanjing Medical University, Nanjing 210004, China)

机构地区：[1]南京医科大学附属南京妇产医院麻醉科,210004

出　　处：《临床麻醉学杂志》2017年第9期848-851,共4页Journal of Clinical Anesthesiology

基　　金：南京医科大学科技发展基金面上项目(2014NJMU091);江苏省科技厅临床医学专项项目(BL2014016)

摘　　要：目的观察硬膜外注射吗啡缓解侧切产妇产后会阴部疼痛的有效性。方法选择要求自然分娩且经历侧切的产妇145例,随机分为三组,脐带结扎后硬膜外分别给予内含1 mg吗啡(M1组)或2mg吗啡(M2组)的生理盐水10ml,或单纯生理盐水10ml(C组)。随访记录产妇产后24h内静息和活动状态现实疼痛强度(present pain intensity,PPI)及活动时PPI中重度疼痛出现时间;同时记录吗啡相关不良反应。结果静息状态PPI中重度疼痛的比例M2组(2.1%)明显低于M1组(15.7%)和C组(19.1%)(P<0.05);活动状态PPI中重度疼痛出现时间M2组(15.7±1.4)h明显晚于M1组(11.0±0.9)h和C组(11.0±1.0)h(P<0.05)。然而,恶心、呕吐、瘙痒、尿潴留的累积发生率M2组(102.1%)明显高于M1组(43.1%)和C组(12.8%)(P<0.05)。结论脐带结扎后硬膜外注射2mg吗啡虽然显著减低产妇静息PPI中重度疼痛的比例并推迟活动时PPI中重度疼痛的出现时间,但是增加了不良反应发生率,需慎重使用。Objective To observe the analgesic efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy.Methods After institutional reviewing board approval and patient consent,a total of 145 parturients requesting epidural labor analgesia and undergoing episiotomy were randomized into three groups：M1,M2,and C,where in morphine 1mg dissolved in saline 10 ml,morphine 2mg dissolved in saline 10 ml,or sole saline 10 ml was epidurally given immediately after umbilical cord clamp,respectively.Perineal pain at rest and movement within24 hours after vaginal delivery were evaluated with present pain intensity（PPI）.Further,the time interval between a moderate or severe PPI and epidural drug treatment were recorded.Besides,epidural morphine related side effects including nausea,vomiting,pruritus,and urinary retention were observed as well.Results The proportion of patients with moderate or severe pain at rest was significantly lower in group M2（2.1%）compared to group M1（15.7）and group C（19.1%）（P〈0.05）.Further,the time interval between a moderate or severe PPI and epidural drug treatment was significantly longer in group M2（15.7±1.4h）compared to group M1（11.0±0.9h）and group C（11.0±1.0h）（P〈0.05）.No significant difference was found between groups M1 and group C with regard to morphine efficacy.However,the accumulated side effects including nausea,vomiting,pruritus,and urinary retention prominently increased in group M2（102.1%）compared to group M1（43.1%）and group C（12.8%）（P〈0.05）.Conclusion Although epidural morphine 2 mg may significantly decrease and postpone the occurrence of moderate or severe postpartum perineal pain,however,it deserves consideration before clinical use owing to the increased side effects.

关 键 词：吗啡 侧切 会阴部疼痛 有效性 

分 类 号：R614[医药卫生—麻醉学]