吗啡用于剖宫产术后硬膜外镇痛效果的适宜剂量  

Appropriate dose of morphine in epidural analgesia after cesarean section

作　　者：刘俊杰[1] 刘玉华[2] 刘雅[3] LIU Junjie;LIU Yuhua;LIU Ya(Department of Anesthesiology,People’s Hospital of Huanghua City,Hebei,Huanghua 061100,China;不详)

机构地区：[1]河北省黄骅市人民医院麻醉科,061100 [2]河北省医学情报研究所 [3]河北医科大学第二医院麻醉科,石家庄市050000

出　　处：《河北医药》2020年第19期2918-2922,共5页Hebei Medical Journal

摘　　要：目的观察硬膜外不同剂量吗啡对剖宫产术后镇痛效果和不良反应发生率的影响。方法选择2018年1~9月行子宫下段剖宫产手术患者90例,年龄20~35岁,身高155~175 cm,体重55~95 kg,孕37~42周,首次妊娠,ASA分级Ⅰ或Ⅱ级,采用随机数字表法,将患者分为M1、M2、M33组,每组30例。M1组为吗啡1 mg组,M2组为吗啡2 mg组,M3组为吗啡3 mg组。均选择腰硬联合麻醉,L2/3椎间隙进行穿刺,腰麻使用0.75%盐酸罗哌卡因1.6~1.8 ml蛛网膜下腔注射,留置硬膜外导管。手术结束前15 min硬膜外腔注入不同剂量吗啡,M1组(吗啡1 mg)、M2组(吗啡2 mg)、M3组(吗啡3 mg)均用0.9%氯化钠溶液稀释至6 ml。手术结束前静脉注射帕洛诺司琼0.25 mg,预防术后恶心呕吐的发生。观察产妇术后2 h、4 h、8 h、24 h、48 h时疼痛的感受并记录视觉模拟评分(VAS)和镇静评分(Ramsay评分),记录术后镇痛补救次数、恶心呕吐、皮肤瘙痒等不良反应的发生率。结果3组产妇年龄(岁),体重指数(kg/m2),孕周(周),ASA分级构成,手术时间(min)比较差异均无统计学意义(P>0.05)。与M1组比较,M2组和M3组在术后2 h、4 h、8 h、24 h、48 h时VAS评分均降低,差异有统计学意义(P<0.05)。与M2组比较,M3组在术后2 h、24 h时VAS评分均降低,差异有统计学意义(P<0.05),在术后4 h、8 h、48 h时VAS评分均升高,差异有统计学意义(P<0.05)。M1组产妇术后镇痛补救率为26%,M2组和M3组未发生术后镇痛补救,镇痛效果良好。M1组中度疼痛的发生率为33%,而M2组中度疼痛的发生率为3%,M3组无中度疼痛的发生,组间比较差异有统计学意义(P<0.05)。M1组术后Ramsay评分1分的发生率为7%,Ramsay评分2分的发生率为93%,M2组和M3组均为Ramsay评分2分,3组间比较差异无统计学意义(P>0.05)。3组产妇术后恶心、呕吐的发生率分别为3%、10%、10%,差异无统计学意义(P>0.05)。M1组和M2组产妇无皮肤瘙痒发生,M3组产妇皮肤瘙痒的发生率为57%。Objective To investigate the analgesic effects of different doses of morphine after cesarean section,and to observe the incidence of adverse reactions after cesarean section.Methods Ninety puerpera who underwent cesarean section in the lower uterus in our hospital from January 2018 to September 2018 were randomly divided into three groups:M1 group,M2 group,and M3 group,with 30 cases in each group.The morphine dose was 1mg in M1 group,2mg in M2 group,and 3mg in M3 group.The patients in the three groups received combined spinal and epidural anesthesia(CSEA),spinal anesthesia 0.75%ropivacaine hydrochloride 1.6 to 1.8ml.And the different doses of morphine were diluted to 6ml with normal saline and injected into the epidural space 15 minutes before the end of operation.Moreover the palonosetron 0.25mg was injected intravenously at the end of surgery to prevent postoperative nausea and vomiting.The visual analogue scale(VAS),sedation score(Ramsay),postoperative analgesic remedy frequency,and the incidence rate of nausea and vomiting,skin itching at 2h,4h,8h,24h,48h after cesarean section were observed and compared among the three groups.Results There were no significant differences in puerpera’s age,body mass index,gestational age,ASA,and operation time among the three groups(P>0.05).As compared with those in M1 group,the VAS scores in M2 group and M3 group at 2h,4h,8h,24h,48h were significantly decreased(P<0.05).As compared with those in M2 group,the VAS scores in M3 group at 2h,24h were significantly decreased(P<0.05),however,which at 4h,8h,48h were significantly increased(P<0.05).The rescue analgesia rate in M1 group was 26%,however,M2 group and M3 group had no rescue analgesia.The incidence of moderate pain in M1 group was 33%,which in M2 group was 3%,but M3 group had no moderate pain.There were significant differences in the incidence rates of rescue analgesia and moderate pain among the three groups(P<0.05).The score 1 of Ramsay sedation scores in M1 group was 7%,the score 2 was 93%.In M2 group and M3 group wer

关 键 词：吗啡 剖宫产术后 硬膜外镇痛 不良反应 

分 类 号：R614.42[医药卫生—麻醉学]