不同浓度曲马多复合布比卡因用于产科镇痛的临床观察

目的比较不同浓度的曲马多复合布比卡因在剖宫产术后硬膜外镇痛的临床效果。方法选择择期剖宫产手术产妇90例。ASAⅠ-Ⅱ级。年龄25-35岁。随机分为3组：Ⅰ组使用0.15%布比卡因;Ⅱ组使用0.15%布比卡因加1.0 mg/mL曲马多;Ⅲ组使用0.15%布比卡因,4.0 mg/mL曲马多行硬膜外镇痛（PCEA）,观察并记录术后4,8,12,24 h视觉模拟评分（VAS）,术后运动神经阻滞评分（改良Bromage评分）。结果对切口痛的抑制Ⅱ组、Ⅲ组的效果要好于Ⅰ组（P〈0.05）,对宫缩的抑制Ⅲ组的效果明显好于其他两组（P〈0.05）,运动神经阻滞3组间差异无显著意义,术后总体满意度Ⅰ组（57%）和Ⅱ组（66%）比较差异无显著意义,Ⅲ组的满意度（94%）明显高于其他两组（P〈0.05）。结论剖宫产后镇痛采用0.15%布比卡因和4.0 mg/mL曲马多复合可明显抑制宫缩痛。

Clinical Observation of Obstetrics Analgesia in Varied Concentration of Tramadol and Bupivacaine

Objective To compare varied concentration of tramadol and bupivacain in epidural analgesia post cesarean section.Methods 90 cases of such patient in ASA Ⅰ～Ⅱ with age of 25～35 were divided into three groups. Group Ⅰ was given 0.15% bupivacaine,Group Ⅱ was given 0.15% bupivacaine and 1 mg/mL tramadol and group Ⅲ was bupivacaine and 4 mg/mL tramadol PCEA.The VAS score and Bromage score at 4,8,12,24 hours after operation.Results The incision pain was stopped better in group Ⅱ and Ⅲ than that in group Ⅰ.The uterine contraction was inhibited better in group Ⅲ that those in group Ⅰ and Ⅱ.There was no significant difference in three group in Bromage score.The satisfactory degree was 57% in group Ⅰ,66% in group Ⅱ and 94% in group Ⅲ. Conclusion The combined use bupivacaine and tramadol in PCEA might have better analgesia effect during U-D with good inhibition of uterus.