小剂量吗啡单次硬膜外推注复合地佐辛静脉泵注用于剖宫产术后镇痛(1)
[摘要] 目的 探讨小剂量吗啡硬膜外腔推注复合地佐辛静脉泵注用于剖宫产术后镇痛的效果。方法 整群选取拟行剖宫产手术患者120例，随机分为A、 B、 C3组，每组40例。A组于关腹膜时给予吗啡1.5 mg(用生理盐水稀释至5 mg)单次硬膜外腔推注，B、C两组于关腹膜时给予生理盐水5 ml单次硬膜外腔推注，术毕均行静脉镇痛(PICA)。A、 B组配方：地佐辛0.6 mg/kg+氟比洛芬酯200 mg+昂丹司琼12 mg；C组配方：芬太尼12 ug/kg+氟比洛芬酯200 mg+昂丹司琼12 mg；均用生理盐水稀释至200 ml。初始负荷剂量4 ml，背景剂量4 ml/h，单次PCA2.0 ml，锁定时间15 min，观察并记录患者术后2、4、8、12、24、48 h的VAS疼痛评分，BCS舒适度评分以及术后24 h内PCA按压次数和不良反应。结果 B、C两组术后2、4、8 hVAS疼痛评分和术后24 h内PCA按压次数高于A组，差异有统计学意义(P<0.05)，B、C两组术后2、4、8 h的BCS舒适度评分低于A组，差异有统计学意义(P<0.05)，3组均未出现呼吸抑制，但C组恶心、呕吐发生率高于A、B组，3组间皮肤瘙痒发生率差异无统计学意义(P>0.05)。结论 小剂量吗啡单次硬膜外推注复合地佐辛静脉泵注用于产科术后镇痛安全有效，术毕最初数小时内镇痛效果更佳，恶心呕吐、眩晕发生率较低。
[关键词] 吗啡；地佐辛；剖宫产；术后镇痛
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)09(c)-0008-03
[Abstract] Objective To investigate the effect of single epidural bolus of low-dose morphine combined with dezocine for postoperative analgesia after cesarean section. Methods 120 patients proposed to undergo cesarean section were randomly divided into three groups， group A， group B and group C with 40 patients in each. At the time of suturing the peritoneum， group A was given single epidural bolus of morphine 1.5 mg diluted with normal saline to 5 mL， group B and group C were given epidural bolus of normal saline 5 mL. Patient-controlled intravenous analgesia (PICA) was given to all the patients after surgery. Patients in group A and group B were given dezocine 0.6 mg/kg， flurbiprofen axetil 200 mg and ondansetron 12 mg diluted with normal saline to 200 mL， and those in group C were given fentanyl 12 ug/kg， flurbiprofen axetil 200 mg and ondansetron 12 mg diluted with normal saline to 200 mL， with the initial loading dose was 4 mL， the background dose was 4 mL/h， PCA 2.0 mL every time， lockout time was 15min. The VAS， BCS 2h， 4h， 8h， 12h， 24h， 48 h after the surgery， PCA pressing times within 24h after the surgery and incidence of adverse reactions of the groups were observed and recorded. Results The VAS of group B and group C at 2h， 4h， 8h after the surgery was much higher than that of group A， respectively (P<0.05). The PCA pressing times within 24h after surgery of group B and group C were more than those of group A， respectively(P<0.05). The BCS of group B and group C at 2h， 4h， 8h after the surgery was much lower than that of group A， respectively. No respiratory depression occurred in the three groups. The incidence of nausea and vomiting of group C was much higher than that of group A and group B. The difference in the incidence itch of skin between the three groups was not statistically significant(P<0.05). Conclusion For the postoperative analgesia after obstetrical surgery， single epidural bolus of low-dose morphine combined with dezocine is safe and effective， and its effect is better within hours after the surgery， the incidence of nausea， vomiting and dizziness is low. (黄庆清 林钗 翁迪贵 梁亚贵)
[关键词] 吗啡；地佐辛；剖宫产；术后镇痛
[中图分类号] R5 [文献标识码] A [文章编号] 1674-0742(2015)09(c)-0008-03
[Abstract] Objective To investigate the effect of single epidural bolus of low-dose morphine combined with dezocine for postoperative analgesia after cesarean section. Methods 120 patients proposed to undergo cesarean section were randomly divided into three groups， group A， group B and group C with 40 patients in each. At the time of suturing the peritoneum， group A was given single epidural bolus of morphine 1.5 mg diluted with normal saline to 5 mL， group B and group C were given epidural bolus of normal saline 5 mL. Patient-controlled intravenous analgesia (PICA) was given to all the patients after surgery. Patients in group A and group B were given dezocine 0.6 mg/kg， flurbiprofen axetil 200 mg and ondansetron 12 mg diluted with normal saline to 200 mL， and those in group C were given fentanyl 12 ug/kg， flurbiprofen axetil 200 mg and ondansetron 12 mg diluted with normal saline to 200 mL， with the initial loading dose was 4 mL， the background dose was 4 mL/h， PCA 2.0 mL every time， lockout time was 15min. The VAS， BCS 2h， 4h， 8h， 12h， 24h， 48 h after the surgery， PCA pressing times within 24h after the surgery and incidence of adverse reactions of the groups were observed and recorded. Results The VAS of group B and group C at 2h， 4h， 8h after the surgery was much higher than that of group A， respectively (P<0.05). The PCA pressing times within 24h after surgery of group B and group C were more than those of group A， respectively(P<0.05). The BCS of group B and group C at 2h， 4h， 8h after the surgery was much lower than that of group A， respectively. No respiratory depression occurred in the three groups. The incidence of nausea and vomiting of group C was much higher than that of group A and group B. The difference in the incidence itch of skin between the three groups was not statistically significant(P<0.05). Conclusion For the postoperative analgesia after obstetrical surgery， single epidural bolus of low-dose morphine combined with dezocine is safe and effective， and its effect is better within hours after the surgery， the incidence of nausea， vomiting and dizziness is low. (黄庆清 林钗 翁迪贵 梁亚贵)