中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2014年
18期
32-35
,共4页
剖宫产术%镇痛%吗啡%氟比洛芬酯%舒芬太尼
剖宮產術%鎮痛%嗎啡%氟比洛芬酯%舒芬太尼
부궁산술%진통%마배%불비락분지%서분태니
Cesarean section%Analgesia%Morphine%Flurbiprofen axetil%Sufentanil
目的 评价静脉注射氟比洛芬酯和舒芬太尼联合硬膜外吗啡用于剖宫产术后镇痛的效果和安全性.方法 将180例ASA分级Ⅰ～Ⅱ级择期剖宫产初产妇按镇痛泵配方不同分为吗啡组(A组)、舒芬太尼+吗啡组(B组)和氟比洛芬酯+舒芬太尼+吗啡组(C组),每组60例.所有产妇均采用蛛网膜下隙联合硬膜外麻醉,关腹后,三组产妇均硬膜外注入吗啡1.5 mg,B组和C组接镇痛泵,舒芬太尼和氟比洛芬酯用0.9％氯化钠稀释到100ml静脉泵注.记录三组术后6,12,24h静息和动态切口痛、宫缩痛的疼痛视觉模拟量表(VAS)评分,镇静程度(Ramsay评分)以及不良反应发生率.结果 B组和C组术后6,12,24h静息和动态切口痛及宫缩痛VAS评分均低于A组[静息切口痛:A组分别为(2.6±0.6)、(2.7±0.4)、(2.8±0.3)分,B组分别为(2.3±0.3)、(2.3±0.4)、(2.2±0.3)分,C组分别为(1.8±0.4)、(1.7±0.5)、(1.9±0.4)分;动态切口痛:A组分别为(5.7±0.9)、(5.5±0.8)、(5.6±1.0)分,B组分别为(3.8±0.4)、(3.7±0.5)、(3.7±0.4)分,C组分别为(2.7±0.4)、(2.4±0.5)、(2.4±0.6)分;宫缩痛:A组分别为(5.7±1.2)、(5.9±0.9)、(5.8±1.1)分,B组分别为(3.0±0.5)、(3.1±0.6)、(3.2±0.7)分,C组分别为(2.5±0.5)、(2.5±0.6)、(2.4±0.4)分],而且C组均低于B组,差异均有统计学意义(P＜0.05).B组和C组术后6,12,24h Ramsay评分高于A组[A组分别为(1.8±0.5)、(1.7±0.4)、(1.9±0.5)分,B组分别为(3.4±0.8)、(3.2±0.7)、(3.3±0.6)分,C组分别为(2.7±0.7)、(2.7±0.5)、(2.6±0.4)分],而且C组均高于B组,差异均有统计学意义(P＜0.05).A组和C组不良反应发生率明显低于B组[8.3％(5/60)和23.3％(14/60)比40.0％(24/60)],而且A组也低于C组,差异均有统计学意义(P＜0.05).结论 氟比洛芬酯与舒芬太尼联合硬膜外吗啡用于剖宫产术后镇痛有协同作用,可以同时缓解产妇切口痛和宫缩痛,效果好且不良反应少.
目的 評價靜脈註射氟比洛芬酯和舒芬太尼聯閤硬膜外嗎啡用于剖宮產術後鎮痛的效果和安全性.方法 將180例ASA分級Ⅰ～Ⅱ級擇期剖宮產初產婦按鎮痛泵配方不同分為嗎啡組(A組)、舒芬太尼+嗎啡組(B組)和氟比洛芬酯+舒芬太尼+嗎啡組(C組),每組60例.所有產婦均採用蛛網膜下隙聯閤硬膜外痳醉,關腹後,三組產婦均硬膜外註入嗎啡1.5 mg,B組和C組接鎮痛泵,舒芬太尼和氟比洛芬酯用0.9％氯化鈉稀釋到100ml靜脈泵註.記錄三組術後6,12,24h靜息和動態切口痛、宮縮痛的疼痛視覺模擬量錶(VAS)評分,鎮靜程度(Ramsay評分)以及不良反應髮生率.結果 B組和C組術後6,12,24h靜息和動態切口痛及宮縮痛VAS評分均低于A組[靜息切口痛:A組分彆為(2.6±0.6)、(2.7±0.4)、(2.8±0.3)分,B組分彆為(2.3±0.3)、(2.3±0.4)、(2.2±0.3)分,C組分彆為(1.8±0.4)、(1.7±0.5)、(1.9±0.4)分;動態切口痛:A組分彆為(5.7±0.9)、(5.5±0.8)、(5.6±1.0)分,B組分彆為(3.8±0.4)、(3.7±0.5)、(3.7±0.4)分,C組分彆為(2.7±0.4)、(2.4±0.5)、(2.4±0.6)分;宮縮痛:A組分彆為(5.7±1.2)、(5.9±0.9)、(5.8±1.1)分,B組分彆為(3.0±0.5)、(3.1±0.6)、(3.2±0.7)分,C組分彆為(2.5±0.5)、(2.5±0.6)、(2.4±0.4)分],而且C組均低于B組,差異均有統計學意義(P＜0.05).B組和C組術後6,12,24h Ramsay評分高于A組[A組分彆為(1.8±0.5)、(1.7±0.4)、(1.9±0.5)分,B組分彆為(3.4±0.8)、(3.2±0.7)、(3.3±0.6)分,C組分彆為(2.7±0.7)、(2.7±0.5)、(2.6±0.4)分],而且C組均高于B組,差異均有統計學意義(P＜0.05).A組和C組不良反應髮生率明顯低于B組[8.3％(5/60)和23.3％(14/60)比40.0％(24/60)],而且A組也低于C組,差異均有統計學意義(P＜0.05).結論 氟比洛芬酯與舒芬太尼聯閤硬膜外嗎啡用于剖宮產術後鎮痛有協同作用,可以同時緩解產婦切口痛和宮縮痛,效果好且不良反應少.
목적 평개정맥주사불비락분지화서분태니연합경막외마배용우부궁산술후진통적효과화안전성.방법 장180례ASA분급Ⅰ～Ⅱ급택기부궁산초산부안진통빙배방불동분위마배조(A조)、서분태니+마배조(B조)화불비락분지+서분태니+마배조(C조),매조60례.소유산부균채용주망막하극연합경막외마취,관복후,삼조산부균경막외주입마배1.5 mg,B조화C조접진통빙,서분태니화불비락분지용0.9％록화납희석도100ml정맥빙주.기록삼조술후6,12,24h정식화동태절구통、궁축통적동통시각모의량표(VAS)평분,진정정도(Ramsay평분)이급불량반응발생솔.결과 B조화C조술후6,12,24h정식화동태절구통급궁축통VAS평분균저우A조[정식절구통:A조분별위(2.6±0.6)、(2.7±0.4)、(2.8±0.3)분,B조분별위(2.3±0.3)、(2.3±0.4)、(2.2±0.3)분,C조분별위(1.8±0.4)、(1.7±0.5)、(1.9±0.4)분;동태절구통:A조분별위(5.7±0.9)、(5.5±0.8)、(5.6±1.0)분,B조분별위(3.8±0.4)、(3.7±0.5)、(3.7±0.4)분,C조분별위(2.7±0.4)、(2.4±0.5)、(2.4±0.6)분;궁축통:A조분별위(5.7±1.2)、(5.9±0.9)、(5.8±1.1)분,B조분별위(3.0±0.5)、(3.1±0.6)、(3.2±0.7)분,C조분별위(2.5±0.5)、(2.5±0.6)、(2.4±0.4)분],이차C조균저우B조,차이균유통계학의의(P＜0.05).B조화C조술후6,12,24h Ramsay평분고우A조[A조분별위(1.8±0.5)、(1.7±0.4)、(1.9±0.5)분,B조분별위(3.4±0.8)、(3.2±0.7)、(3.3±0.6)분,C조분별위(2.7±0.7)、(2.7±0.5)、(2.6±0.4)분],이차C조균고우B조,차이균유통계학의의(P＜0.05).A조화C조불량반응발생솔명현저우B조[8.3％(5/60)화23.3％(14/60)비40.0％(24/60)],이차A조야저우C조,차이균유통계학의의(P＜0.05).결론 불비락분지여서분태니연합경막외마배용우부궁산술후진통유협동작용,가이동시완해산부절구통화궁축통,효과호차불량반응소.
Objective To investigate the analgesic effect and the safety assessment of intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine for post-cesarean analgesia.Methods One hundred and eighty parturients (ASA Ⅰ-Ⅱ) undergoing elective cesarean section with combined spinal and epidural anesthesia were divided into morphine group (group A),sufentanil + morphine group(group B),flurbiprofen axetil+sufentanil+ morphine group(group C) with 60 cases in each group.All patients were used subarachnoid epidural anesthesia,at the end of the surgery,1.5 mg morphine diluted to 5 ml saline was injected into the epidural space of each patient.Additional,group B and group C received patient-controlled intravenous analgesia after cesarean section.Flurbiprofen axetil and sufentanil were diluted to 100 ml with saline.The visual analog scale (VAS) of rest and dynamic incisional pain and uterine contraction pain,Ramsay sedation scale (RSS),and adverse events were recorded at 6,12,24 h after operation.Results At 6,12,24 h after operation,the VAS scores of rest and dynamic incisional pain and uterine contraction pain in group B and group C were statistically lower than those in group A [rest incisional pain:(2.6 ± 0.6),(2.7 ± 0.4),(2.8 ± 0.3)scores in group A; (2.3 ± 0.3),(2.3 ± 0.4),(2.2 ± 0.3) scores in group B; (1.8 ± 0.4),(1.7 ±0.5),(1.9 ±0.4) scores in group C; dynamic incisional pain:(5.7 ±0.9),(5.5 ± 0.8),(5.6 ± 1.0) scores in group A; (3.8 ± 0.4),(3.7 ± 0.5),(3.7 ± 0.4) scores in group B ; (2.7 ± 0.4),(2.4 ± 0.5),(2.4 ± 0.6) scores in group C ; uterine contraction pain:(5.7 ± 1.2),(5.9 ± 0.9),(5.8 ± 1.1) scores in group A; (3.0 ± 0.5),(3.1 ± 0.6),(3.2 ± 0.7)scores in group B; (2.5 ± 0.5),(2.5 ± 0.6),(2.4 ± 0.4) scores in group C],and group C were lower than group B,and there were significant differences (P＜0.05).At 6,12,24 h after operation,Ramsay score in group B and group C was higher than that in group A [(1.8 ± 0.5),(1.7 ± 0.4),(1.9 ± 0.5) scores in group A; (3.4 ± 0.8),(3.2 ± 0.7),(3.3 ± 0.6) scores in group B; (2.7 ±0.7),(2.7 ±0.5),(2.6 ± 0.4)scores in group C],and group C was higher than group B,and there were significant differences (P ＜ 0.05).The incidence of adverse events in group A and group C was lower than group B [8.3％(5/60) and 23.3％(14/60) vs.40.0％(24/60)],and group A was lower than group C,and there were significant differences (P ＜ 0.05).Condusion Intravenous injection of flurbiprofen axetil and sufentanil combined with epidural morphine could perform better analgesic on postoperative incisional and uterine contraction pain after cesarean section and the incidence of adverse events is less than sufentanil combined with morphine.
