清醒镇静镇痛在产后乳腺炎乳房按摩中的临床应用观察  

Clinical Application Observation of Conscious Analgesia in Breast Massage of Postpartum Mastitis

作　　者：江金环 刘纳新 童梅 黄艳 JIANG Jinhuan;LIU Naxin;TONG Mei;HUANG Yan(Anesthesiology Department,Guangzhou Haizhu District Maternal and Child Health Hospital,Guangzhou,Guangdong,510240)

机构地区：[1]广东省广州市海珠区妇幼保健院麻醉科,广东广州510240

出　　处：《智慧健康》2022年第21期125-128,共4页Smart Healthcare

摘　　要：目的观察清醒镇静镇痛在产后乳腺炎行乳房按摩中的临床应用效果及安全可行性。方法选择2018年1月-2019年6月间ASAⅠ-Ⅱ级的产后乳腺炎需行乳房按摩治疗病例70例。随机分为RF组和SF组,各35例,RF组采用瑞芬太尼[首剂1μg/kg,持续泵注0.05~0.1μg/(kg·min)]+咪达唑仑(0.02mg/kg);SF组采用舒芬太尼(0.1~0.2μg/kg)+咪达唑仑(0.02mg/kg)。记录用药前(T0)、用药后5min(T1)、10min(T2)、治疗结束时(T3)两组患者的NBP、HR、SPO_(2)的数值,评估两组治疗中的镇痛效果(VAS评分)、镇静程度(OAA/S、Ramsay评分),及低氧血症、呼吸暂停、心动过缓等发生情况,术后记录有无眩晕、头痛、恶心、呕吐等ADR(药物不良反应)及随访患者的舒适满意度。结果两组OAA/S、VAS、Ramsay得分对比,P>0.05。RF组患者在T1时间段血压和心率较T0时段有所下降,但差异无统计学意义(P>0.05);SF组T1时间段血压和心率较T0时段明显下降,P<0.05;其他各时段,组间及组内各指标比较,均无明显差异,P>0.05。RF组和SF组ADR发生率分别为2.86%、5.72%,组间对比P>0.05。结论行乳房按摩的产后乳腺炎患者可采用瑞芬太尼或舒芬太尼+小剂量咪达唑仑等方式实施清醒镇静镇痛,帮助缓解乳房按摩过程中的疼痛,促进按摩顺利完成。两组剂量和注药速率均能达到治疗中的镇痛、镇静作用,减少不良反应,治疗结束后表达清晰,多数无不适感觉。笔者认为,两组用药方案均可安全用于乳房按摩,以瑞芬太尼更具有优势,值得临床推广。Objective To observe clinical effect and safety feasibility of conscious sedation in breast massage for postpartum mastitis.Methods The paper chose 70 patients with ASA I-II postpartum mastitis with breast massage from January 2018 to June 2019,and divided them into RF group and SF group randomLy,with 35 cases in each group.RF group was treated with remifentanil[first dose 1μG/kg,continuous pumping 0.05~0.1μG/(kg·min)]+midazolam(0.02mg/kg);SF group with sufentanil(0.1~0.2μG/kg)+midazolam(0.02mg/kg).NBP,HR and SpO_(2)of two groups was recorded before treatment(T0),5min(T1),10min(T2)after treatment and at end of treatment(T3).Analgesic effect(VAS scores),sedation degree(OAA/S,Ramsay scores),hypoxemia,apnea,bradycardia and other occurrences were evaluated in two groups during treatment.ADR(adverse drug reactions)such as dizziness,headache,nausea,vomiting and comfort satisfaction degree of follow-up patients were recorded after operation.Results Scores comparison of OAA/S,VAS,Ramsay between two groups showed P>0.05.in RF group,blood pressure and heart rate decreased in T1 period compared with T0 period,difference was not statistically significant(P>0.05).in SF group,blood pressure and heart rate in T1 period was significantly lower than t0 period(P<0.05),with no significant difference in other periods between groups and within groups(P>0.05).Incidence of ADR in RF group and SF group was 2.86%and 5.72%respectively,comparison between groups showed P>0.05.Conclusion Remifentanil or sufentanil+low-dose midazolam can alleviate pains during breast massage and promote smooth completion of massage of patients with postpartum mastitis undergoing breast massage during conscious sedation and analgesia,dosage and injection rate of two groups can achieve analgesic and sedative effect,reduce adverse reactions,with clear expression after treatment,no discomfort for most of them.The author believes that two schmes can be safely applied for breast massage,and remifentanil has more advantages,which is worthy of clinical promotion.

关 键 词：清醒镇痛 产后乳腺炎 乳房按摩 镇静镇痛 

分 类 号：R614[医药卫生—麻醉学]