CAJ | 학술논문

目的比较静脉注射氟比洛芬酯和硬膜外注射曲马多单独和联合应用的4种用药方式对剖宫产手术术后疼痛的镇痛效果.方法 80例在腰麻硬膜外联合阻滞下行择期剖宫产的产妇被随机分为4组,每组20例:FT组在胎儿娩出夹闭脐带即刻(T1)静脉注射氟比洛芬酯50 mg,关腹膜时(T2)硬膜外注射曲马多100 mg;FF组在T1和T2时点分别静脉注射氟比洛芬酯50 mg;T组仅在T2时点硬膜外注射曲马多100 mg;F组仅在T2静脉注射氟比洛芬酯50 mg.观察术后2、4、8、12、24 h的疼痛视觉模拟评分(visual analog scales,VAS),记录术后需要实施补救镇痛的产妇例数及补救镇痛的次数,记录产妇24 h内恶心或呕吐的情况及泌乳发动时间.结果 4组产妇术后2 h的VAS比较无统计学差异,而术后4、8、12和24 h FF组明显低于其余3组(P<0.05),而其余3组间差异无统计学意义.F组有7例,T组有4例,FT组有2例术后使用镇痛药, FF组无产妇术后需要补救镇痛,4组比较有统计学差异(P=0.014 9).恶心呕吐的发生率4组间差异无统计学意义.4组产妇术后泌乳发动时间比较无统计学差异(F=0.54,P=0.657).结论剖宫产手术胎儿娩出即刻及关腹时分别给予静脉氟比洛芬酯脂微球注射液能有效缓解术后疼痛,减少术后镇痛药的需要,是一种安全有效的镇痛方法.
목적 비교정맥주사불비락분지화경막외주사곡마다단독화연합응용적4충용약방식대부궁산수술술후동통적진통효과.방법 80례재요마경막외연합조체하행택기부궁산적산부피수궤분위4조,매조20례:FT조재태인면출협폐제대즉각(T1)정맥주사불비락분지50 mg,관복막시(T2)경막외주사곡마다100 mg;FF조재T1화T2시점분별정맥주사불비락분지50 mg;T조부재T2시점경막외주사곡마다100 mg;F조부재T2정맥주사불비락분지50 mg.관찰술후2、4、8、12、24 h적동통시각모의평분(visual analog scales,VAS),기록술후수요실시보구진통적산부례수급보구진통적차수,기록산부24 h내악심혹구토적정황급비유발동시간.결과 4조산부술후2 h적VAS비교무통계학차이,이술후4、8、12화24 h FF조명현저우기여3조(P<0.05),이기여3조간차이무통계학의의.F조유7례,T조유4례,FT조유2례술후사용진통약, FF조무산부술후수요보구진통,4조비교유통계학차이(P=0.014 9).악심구토적발생솔4조간차이무통계학의의.4조산부술후비유발동시간비교무통계학차이(F=0.54,P=0.657).결론 부궁산수술태인면출즉각급관복시분별급여정맥불비락분지지미구주사액능유효완해술후동통,감소술후진통약적수요,시일충안전유효적진통방법.
Objective To assess the effect and safety of mono and combination of intravenous flurbiprofen axetil (FP) and epidural tramadol on postoperative pain after cesarean section. Methods Eighty parturients undergoing selected cesarean section with combined epidural spinal anesthesia were randomly allocated into 4 groups (n=20 in each): Group FT treated with intravenous FP 50 mg immediately after the umbilical cord was clamped (T1) and epidural tramadol at the time of suturing peritonaeum (T2);Group FF treated with intravenous FP 50 mg at T1 and T2;Group T treated with epidural tramadol 100 mg at T2, and Group F treated with FP 50 mg at T2. Postoperative pain was assessed by parturients using visual analog scales (VAS) at 2, 4, 8, 12, 24 h after surgery. The cases that patients required rescued analgesia were recorded as well as the times of analgesics administration. The events of nausea and vomiting within 24 hours as well as the time of first breast-feeding were observed. Results All groups were similar in VAS at 2 hours after surgery, but were statistically significant different at 4, 8, 12 and 24 hours. Group FF showed significant lower VAS than the other 3 groups. However, no significant difference of VAS was observed among the other 3 groups. Rescued analgesia was administered once after surgery to 7 cases in Group F, 4 in Group T, and 2 in Group FT. No patient in Group FF required rescued analgesia. There was significant difference in the rate of rescued analgesia post surgery among the 4 groups (P=0.0149). No significance in the incidence of nausea and vomiting was observed in 4 groups. There was no significant difference in the time of first breast-feeding after surgery in the 4 groups (F=0.54,P=0.657). Conclusions Intravenous flurbiprofen axetil administration immediately after the umbilical cord is clamped and at the time of closing peritonaeum in cesarean section could relieve postoperative pain and reduce postoperative rescue analgesic requirement without increasing the incidence of nausea and vomiting.