两种不同镇痛方式用于剖宫产术后镇痛的比较

目的：比较硬膜外自控镇痛和静脉自控镇痛两种术后镇痛方式用于剖宫产术后镇痛的疗效及对母乳喂养的影响，旨在选择一种适宜于产妇的术后镇痛方式。方法选择择期行剖宫产手术的患者100例，随机分为A、B两组，A组为硬膜外自控镇痛组（n＝50），B组为静脉自控镇痛组（n＝50）。观察两组患者术后疼痛视觉模拟评分（VAS）、运动神经阻滞评分（Bromage评分）、不良反应（恶心呕吐、皮肤瘙痒、尿潴留）的发生情况、24h内哺乳次数、人工喂养添加率。结果 A组VAS评分在4h、6h、12h、24h时点明显低于B组（t值分别为4．17、2．80、4．21、18．24，均P＜0．01）。两组Bromage评分在2h、4h、6h、12h、24h、48h各时点均无明显差异（t值分别为0．00、0．51、1．25、0．28、0．39、0．56，均P＞0．05）。 B组恶心呕吐发生率高于A组（χ^2＝5．10，P＜0．05），两组皮肤瘙痒和尿潴留发生率无明显差异（χ^2值分别为0．61、0．84，均P＞0．05）。 A组48h内母乳喂养次数明显多于B组（t＝3．04，P＜0．01），人工喂养添加率低于B组（χ^2＝4．40，P＜0．05）。结论硬膜外自控镇痛为更适合于剖宫产的术后镇痛方式。

Comparison of two different methods of analgesia for cesarean section

Objective To compare the curative effect of patient-controlled epidural analgesia and patient-controlled intravenous analgesia in post-cesarean section pain management and their influence on breastfeeding .Methods A total of 100 pregnant women scheduled for cesarean section were randomly divided into two groups .Group A was the patient-controlled epidural analgesia group （n=50）, and group B was the patient-controlled intravenous analgesia group （ n =50 ） .Pain visual analog scores （ VAS ） , Bromage scores , incidence of adverse reaction （nausea/vomiting, itching, urinary retention）, breastfeeding frequency within 24h and proportion of artificial feeding were observed.Results The VAS at 4h, 6h, 12h and 24h was significantly lower in group A than in group B （t value was 4.17, 2.80, 4.21 and 18.24, respectively, all P〈0.01）.The Bromage scores were similar in both groups （t value was 0.00, 0.51, 1.25, 0.28, 0.39 and 0.56, respectively, all P〉0.05）.The incidence rate of nausea and vomiting in group B was higher than group A （χ^2 =5.10,P〈0.05）.There was no significant differences in incidence rate of itching and urinary retention between two groups （χ^2 value was 0.61 and 0.84, respectively, both P〉0.05）.In group A the breastfeeding frequency in 48h was significantly higher （t=3.04,P〈0.01）, but proportion of artificial feeding was lower （χ^2 =4.40,P〈0.05）.Conclusion Patient-controlled epidural analgesia is better than patient-controlled intravenous analgesia for cesarean section .