吗啡与地佐辛硬膜外单次推注在剖宫产术后镇痛的应用效果  

Application effect of single epidural injection of morphine versus dezocine in analgesia after cesarean section

作　　者：韦宁 廖艳英 韦珊珊[1] WEI Ning;LIAO Yan-ying;WEI Shan-shan(Department of Anesthesiology,the Third People′s Hospital of Hechi City,Hechi 547000,China)

机构地区：[1]广西河池市第三人民医院麻醉科,河池市547000

出　　处：《广西医学》2020年第23期3068-3071,共4页Guangxi Medical Journal

基　　金：广西医药卫生科研课题(Z20170933)。

摘　　要：目的吗啡与地佐辛硬膜外单次推注在剖宫产术后镇痛的应用效果。方法将90例行剖宫产手术的孕妇随机分为A组、B组、C组,每组30例。所有孕妇均采用腰硬联合麻醉,按常规方法行剖宫产手术,手术结束缝皮前,A组给予吗啡2 mg+生理盐水5 mL硬膜外推注,B组给予地佐辛5 mg+生理盐水5 mL硬膜外推注,C组给予生理盐水5 mL硬膜外推注;3组产妇术后自觉疼痛、需要镇痛处理时均给予硬膜外自控镇痛(PCEA)。记录3组术后2 h(T 1)、4 h(T 2)、8 h(T 3)、12 h(T 4)、24 h(T 5)、36 h(T 6)的疼痛视觉模拟量表(VAS)评分;记录3组产妇术后用PCEA启用时间、肛门排气时间、自控镇痛按压次数及术后不良反应。结果3组产妇VAS评分均有随时间延长而下降趋势,C组产妇在T 1、T 2、T 3时点的VAS评分均高于A组、B组(均P<0.05);C组术后PCEA启用时间、自控镇痛按压次数早于/多于A、B组(P<0.05);A、B两组的各时间点VAS评分、术后PCEA启用时间、自控按压次数差异均无统计学意义(均P>0.05);A组恶心呕吐发生率高于B、C组(P<0.05)。结论吗啡或地佐辛硬膜外单次推注用于剖宫产术后镇痛效果相当,且不影响胃肠蠕动功能恢复,但吗啡致恶心呕吐发生率高。Objective To compare the application effect of single epidural injection of morphine versus dezocine in analgesia after cesarean section.Methods Ninety pregnant women undergoing cesarean section were randomly divided into group A,group B and group C,with 30 cases in each group.All pregnant women were anesthetized with combined spinal and epidural anesthesia,and cesarean section was performed according to the conventional approach.At the end of operation and before skin suture,group A received a single epidural injection of 2 mg morphine+5 mL normal saline,group B received a single epidural injection of 5 mg dezocine+5 mL normal saline,group C received a single epidural injection of 5 mL normal saline;puerperae in the three groups undertook patient-controlled epidural analgesia(PCEA)when they felt pain consciously and needed analgesia treatment after operation.The Visual Analogue Scale(VAS)pain scores were recorded in the three groups two(T 1),four(T 2),eight(T 3),12(T 4),24(T 5)and 36 hours(T 6)after operation;the time of PCEA initiation,anal exhaust time,and number of patient-controlled analgesia pump press after operation,as well as postoperative adverse reactions were recorded among puerperae of the three groups.Results Puerperae′s VSA scores decreased over time in the three groups,puerperae in group C exhibited higher VAS scores at time points T 1,T 2 and T 3 than groups A and B(all P<0.05);group C had earlier PCEA initiation and greater number of patient-controlled analgesia pump press than groups A and B(P<0.05);there was no statistically significant difference in VAS score at any time point,postoperative PCEA initiation time,or number of patient-controlled pump press between group A and group B(all P>0.05);the incidence rate of nausea and vomiting in group A was higher than that in group B or C(P<0.05).Conclusion Single epidural injection of either morphine or dezocine provides similar analgesic effect after cesarean section,and does not affect the recovery of gastrointestinal peristalsis,but morphine ex

关 键 词：剖宫产 术后镇痛 吗啡 地佐辛 硬膜外单次推注 效果 

分 类 号：R614[医药卫生—麻醉学]