不同镇痛模式对二次剖宫产术后镇痛效果的比较研究  

A comparative study on the analgesic effects of different modes of analgesia after the secondary cesarean section

作　　者：尹长久[1] 李妍[2] 王吉彬[1] 陈丽[1] YIN Chang-jiu;LI Yan;WANG Ji-bin;CHEN Li(Anesthesiology Department of Jilin Maternal and Child Health Hospital,Changchun,Jilin 130000,China;不详)

机构地区：[1]吉林省妇幼保健院麻醉科,吉林长春130000 [2]吉林省妇幼保健院手术室

出　　处：《中国妇幼保健》2024年第15期2790-2794,共5页Maternal and Child Health Care of China

基　　金：吉林省科学技术厅科技发展计划项目(20200403111SF)。

摘　　要：目的 比较不同镇痛模式的效果,选出能够显著减轻二次剖宫产术后疼痛程度的镇痛模式。方法 选取2020年1月—2022年1月于吉林省妇幼保健院行二次剖宫产的产妇90例,随机分成3组,每组30例。A组、B组镇痛模式是手术完成后给予硬膜外腔吗啡2.5 mg,联合超声引导下行双侧腰方肌神经阻滞麻醉(QLB),加口服扶他林50 mg,术后4 h肚脐至耻骨联合区域针刺试验疼痛评分为0分的产妇列入A组,术后4 h肚脐至耻骨联合区域针刺试验疼痛评分为1~3分的产妇列入B组;C组镇痛模式是手术后给予硬膜外腔吗啡2.5 mg,加口服扶他林50 mg。记录术后4、8、12、24、48 h静息状态和运动状态视觉模拟评分法(VAS评分),改良Bromage评分,Ramsay镇静评分及扶他林开始用药时间、用药次数及用药频率,术后产妇子宫收缩疼痛次数,总体镇痛满意度,术后不良反应发生率。结果 与A组比较,B组、C组产妇术后不同时间点宫缩疼痛次数,静息状态和运动状态VAS评分均明显升高(均P<0.05)。3组产妇剖宫产术后不同时间点Ramsay镇静评分比较,差异均无统计学意义(均P>0.05)。A组、B组、C组总体镇痛满意度分别为93.3%、63.3%、50.0%,与A组比较,B组、C组术后总体镇痛满意度均显著降低(χ^(2)=7.954,13.871,均P<0.05)。与A组比较,B组、C组产妇术后不良反应发生率增加,但差异均无统计学意义(χ^(2)=3.774,2.857,均P>0.05)。A组、B组、C组排气时间分别为(20.1±2.5)h、(25.1±3.0)h、(31.1±3.9)h, 3组排气时间比较,差异有统计学意义(F=88.733,P<0.05)。A组、B组、C组扶他林开始用药时间分别为(21.3±1.6)h、(14.1±1.2)h、(9.9±1.2)h,用药次数分别为(3.3±0.2)次、(4.2±0.2)次、(4.8±0.1)次,用药频率分别为(14.4±0.9)h/次、(11.3±0.4)h/次、(10.1±0.3)h/次。3组产妇剖宫产术后开始用药时间、用药次数及用药频率比较,差异均有统计学意义(F=573.085,442.250,458.187,均P<0.05)。除B组1例年�Objective To compare the analgesic effects of different analgesic modes and select the one that can significantly reduce pain level after the secondary cesarean section.Methods Ninety cases undergoing the secondary cesarean section in Jilin Maternal and Child Health Hospital from January 2020 to January 2022 were selected and randomly divided into three groups,30 cases in each group.The analgesic mode in group A and group B was 2.5 mg of morphine in the epidural space after operation,combined with ultrasound-guided bi-lateral quadratus lumborum block(QLB),and oral diclofenac diethylamine emulgel 50 mg,the grouping criteria:the parturients with acu-puncture test pain score of O from navel to pubic symphysis area at 4 hours afer operation were included in group A,and the parturients with acupuncture test pain score of 1-3 from navel to pubic symphysis area at 4 hours afer operation were included in group B.The analgesic mode in group C was 2.5 mg of morphine in the epidural space after operation,combined with oral diclofenac diethylamine emulgel 50 mg.Visual analogue scale(VAS)scores of the resting and exercise states,modified Bromage scores,Ramsay sedation scores after 4,8,12,24,and 48 hours after operation,the starting time,usage times,and frequencies of diclofenac diethylamine emulgel,postoperative uterine con-traction pain times,overall analgesia satisfaction rates,and incidence rates of postoperative adverse reactions in the two groups were com-pared.Results Postoperative uterine contraction pain times,VAS scores of the resting and exercise states at different time points in group B and group C were significantly higher than those in group A(P<0.05).There was no statistically significant difference in Ramsay sedation scores at dfferent time points among the three groups(P>0.05).The overall analgesia satisfaction rates in group A,group B,and group C were 93.3%,63.3%,and 50.0%,respectively,compared with group A,the overall analgesia satisfaction rates in group B and group C de-creased significantly(χ^(2)=7.954,

关 键 词：双侧腰方肌神经阻滞麻醉 镇痛模式 二次剖宫产 

分 类 号：R719[医药卫生—妇产科学]