羟考酮联合曲马多静脉镇痛对剖宫产术后导尿管相关膀胱刺激征预防效果观察

目的 观察羟考酮联合曲马多静脉镇痛对剖宫产术后导尿管相关膀胱刺激征(CRBD)的预防效果.方法 100例连续硬脊膜外隙阻滞麻醉下行择期剖宫产术产妇,单胎,孕周>37周,ASAⅠ或Ⅱ级,年龄25~35岁,体质量55~85 kg.随机分为羟考酮组(O组)和吗啡组(M组).术毕O组静脉缓慢注射羟考酮0.07 mg·kg-1,硬脊膜外间隙注射生理盐水5 mL;M组静脉注射等容量生理盐水,硬脊膜外间隙注射吗啡1 mg.之后行静脉病人自控镇痛(PCIA),持续输注速度为2 mL·h-1,每次0.5 mL,锁定时间为15 min.术后6 h拔除导尿管.观察并记录手术后1、3、6 h产妇警觉/镇静评分(OAA/S)和疼痛VAS评分;记录术后6 h产妇CRBD发生情况和程度,以及术后8 h内相关不良反应和PCIA按压次数.结果 两组产妇手术后1、3、6 h OAA/S和疼痛VAS评分差异无统计学意义(P>0.05),CRBD发生情况和程度差异无统计学意义(P>0.05),两组产妇术后8 h内皮肤瘙痒、术后恶心呕吐(PONV)、嗜睡、呼吸抑制发生率,以及PCIA按压次数差异无统计学意义(P>0.05),但M组尿潴留发生率高于O组(P<0.05).结论 术毕静脉注射羟考酮联合曲马多静脉镇痛可有效预防剖宫产术后CRBD的发生,且拔除导尿管后尿潴留发生率低.

Efficacy of oxycodone combined with tramadol in the prevention of catheter-related bladder discomfort for cesarean patients

Objective To evaluate the efficacy of oxycodone combined with tramadol in the prevention of catheter-related bladder discomfort(CRBD) for cesarean patients.Methods One hundred patients of ASA Ⅰ or Ⅱ,25-35 years old,weighing 55-85 kg,undergoing elective cesarean,were randomized into two groups:Oxycodone group(Group O,n=50) and morphine group(Group M,n=50).Oxycodone (0.07 mg·kg-1)was injected intravenously in Group O,while 1 mgmorphine was injectedin epidural space in group M after cesarean.Then the patient-controlled intravenous analgesia(PCIA) was received in each group,the continuous infusion rate was 2 mL · h-1,0.5 mL each time,and the lock time was 15 min.The OAA/S rating scale and pain of VAS scoring at 1,3,6 h postoperatively were recorded.The occurrence and severity of CRBD were recorded within 6 h after cesarean.The adverse reactions and the pressing times of patient-controlled intravenous analgesia were also recorded within 8 h after operation.Results There was no significant difference between the two groups in the OAA/S rating scale and pain of VAS scoring at 1,3,6 h postoperatively.Adverse reactions and the pressing times of patient-controlled intravenous analgesia also showed no statistically significant difference between the two groups,but the incidence of urinary retention in Group M was significantly higher than that in Group O(P<0.05).Conclusion Oxycodone combined with tramadol after cesareaninjected intravenouslycan prevent the CRBD effectively without obvious adverse reaction,and the incidence of urinary retention after urethral catheter is low.