CAJ | 학술논문

目的观察硬膜外腔单次注入吗啡对剖宫产术后地佐辛静脉自控镇痛的疗效和不良反应的影响.方法选择60例ASA Ⅰ ～Ⅱ级剖宫产产妇,按随机数字和信封法分成对照组和试验组,每组30例.其中试验组在取出胎儿后硬膜外腔注入吗啡1.5 mg(用5ml 0.9％氯化钠稀释);对照组硬膜外腔注入等量0.9％氯化钠.两组均采用蛛网膜下隙与硬膜外联合阻滞,胎儿取出后静脉注射地佐辛5 mg.术后镇痛采用地佐辛静脉自控镇痛,镇痛液为地佐辛25 mg+0.9％氯化钠至100ml,输注速率2 ml/h.采用视觉模拟量表(VAS)评分评估镇痛效果,记录不良反应的发生情况.记录产妇术后48 h内哺乳次数.于麻醉前、术后24 h采静脉血2ml用放射免疫法测定泌乳素浓度.结果试验组术后6,12h的VAS评分均明显低于对照组[(2.3±1.2)分比(3.1±1.0)分、(2.5±1.3)分比(3.3±1.5)分],差异有统计学意义(P＜0.05);而两组术后2,24,48 h的VAS评分比较差异无统计学意义(P＞0.05).两组恶心呕吐、皮肤瘙痒、头晕、尿潴留、下肢麻木、呼吸抑制发生率比较差异无统计学意义(P＞0.05).试验组产妇术后48 h内哺乳次数多于对照组[(15.2±5.5)次比(11.6±6.8)次],差异有统计学意义(P＜0.05).两组产妇术后24h血浆泌乳素浓度比较差异无统计学意义(P＞0.05).结论硬膜外腔单次注入吗啡可以提高剖宫产产妇术后地佐辛静脉自控镇痛的效果,有利于产妇哺乳,但不增加不良反应.
목적 관찰경막외강단차주입마배대부궁산술후지좌신정맥자공진통적료효화불량반응적영향.방법 선택60례ASA Ⅰ ～Ⅱ급부궁산산부,안수궤수자화신봉법분성대조조화시험조,매조30례.기중시험조재취출태인후경막외강주입마배1.5 mg(용5ml 0.9％록화납희석);대조조경막외강주입등량0.9％록화납.량조균채용주망막하극여경막외연합조체,태인취출후정맥주사지좌신5 mg.술후진통채용지좌신정맥자공진통,진통액위지좌신25 mg+0.9％록화납지100ml,수주속솔2 ml/h.채용시각모의량표(VAS)평분평고진통효과,기록불량반응적발생정황.기록산부술후48 h내포유차수.우마취전、술후24 h채정맥혈2ml용방사면역법측정비유소농도.결과 시험조술후6,12h적VAS평분균명현저우대조조[(2.3±1.2)분비(3.1±1.0)분、(2.5±1.3)분비(3.3±1.5)분],차이유통계학의의(P＜0.05);이량조술후2,24,48 h적VAS평분비교차이무통계학의의(P＞0.05).량조악심구토、피부소양、두훈、뇨저류、하지마목、호흡억제발생솔비교차이무통계학의의(P＞0.05).시험조산부술후48 h내포유차수다우대조조[(15.2±5.5)차비(11.6±6.8)차],차이유통계학의의(P＜0.05).량조산부술후24h혈장비유소농도비교차이무통계학의의(P＞0.05).결론 경막외강단차주입마배가이제고부궁산산부술후지좌신정맥자공진통적효과,유리우산부포유,단불증가불량반응.
Objective To observe the effects and the adverse reactions of single injection ofmorphine into epidural space on patient controlled intravenous analgesia with dezocine for parturient aftercesarean section.Methods Sixty patients with ASA grade Ⅰ or Ⅱ undergoing cesarean section wererandomly divided into control group and experimental group by random digits table and envelope method with30 cases each.The morphine 1.5 mg (diluted with 5 ml saline) was injected into epidural space after thefetus removed in experimental group while the amount of saline was injected in control group.In both groups,the combined epidura-spinal anesthesia was adopted and dezocine 5 mg was administrated intravenously afterthe fetus removed.The patient controlled intravenous analgesia with dezocine was used for postoperativeanalgesia and dezocine 25 mg diluted with saline 100 ml for analgesic solution with infusion rate of 2 ml/h.The analgesic effect was evaluated with visual analogue scale (VAS) and the adverse reactions were recorded.The times of breasffeeding for neonate during 48 h after cesarean section was recorded.The concentration of prolactin was determined with radioimmunity method through 2 ml venous blood sample before anesthesia and 24 h after cesarean section.Results The VAS score at 6,12 h after operation in experimental group was lower than that in control group [(2.3 ± 1.2) scores vs.(3.1 ± 1.0) scores,(2.5 ± 1.3)scores vs.(3.3 ± 1.5) scores],and there was significant difference (P ＜ 0.05),while there was no significant difference in the VAS score at 2,24,48 h after operation between two groups (P＞ 0.05).There was no significant difference in the incidence of adverse reactions such as nausea and vomiting,skin itching,dizziness,urinary retention,lower limb numbness,respiratory depression between two groups (P ＞ 0.05).The times of breastfeeding for neonate during 48 h after cesarean section in experimental group was higher than that in control group [(15.2 ± 5.5) times vs.(11.6 ± 6.8) times],and there was significant difference (P ＜ 0.05).There was no significant difference in the maternal blood concentration of prolactin at 24 h after operation between two groups (P ＞ 0.05).Conclusion The single injection of morphine into epidural space can enhance the analgesia effect of intravenous analgesia with dezocine,do not increase the adverse reaction and is benefit for the breasffeeding for neonate on parturient after cesarean section.