硬膜外镇痛联合应用乙酰氨基酚在剖宫产术后的镇痛效果

目的：比较对乙酰氨基酚联合自控硬膜外镇痛的多模式术后镇痛与单纯自控硬膜外镇痛用于剖宫产产妇术后镇痛效果。方法：200名行剖宫产的产妇随机分为实验组（S组）和对照组（C组），S组产妇在术前15min静脉注射对乙酰氨基酚1g，C组产妇在术前15min静脉注射安慰剂（生理盐水）。两组产妇均采用腰硬联合麻醉方案，缝合切口时启动自控硬膜外镇痛泵。术前、术后即刻、术后1天、术后2天观察疼痛强度和血清IL-6、IL -10水平；记录新生儿出生Apgar评分、术后阿片类药物使用量及术后不良反应、产妇满意度和对母乳喂养的影响程度。结果：术后1天疼痛评分S组显著低于C组。术后即刻、术后1天S组IL-6表达水平低于C组，而该时点S组IL-10表达水平高于C组（P＜0.05）。两组间不良反应、新生儿出生Apgar评分、产妇满意度和母乳喂养情况无统计学差异（P＞0.05）。结论：剖宫产术前静脉注射对乙酰氨基酚联合自控硬膜外镇痛比单独应用自控硬膜外镇痛能够为产妇提供更好的术后疼痛管理。

Compare the analgesia effect of acetaminophen combined with postoperative continous epidural analgesia in cesarean delivery

Objective: To compare the analgesic effect of acetaminophen combined with Postoperative continous epidural analgesia (PCEA) multi-mode postoperative analgesia model and PCEA alone in women after cesarean delivery. Methods: 200 puerpera undergoing cesarean section were selected and randomly divided into experimental group (group S) and control group (group C). The puerpera in group S were given acetaminophen 1g intravenously 15min before operation, and the puerpera in group C were given placebo (normal saline) intravenously 15min before operation. All of the patients were given combined lumbar and epidural anesthesia, and PCEA analgesic pump was started at the time of surgical incision suture. The primary outcomes included pain intensity and serum levels of IL-6, IL-10 at the following time points, preoperation, immediately after surgery, 1 and 2 days after surgery..The secondary outcomes were neonatal Apgar score, postoperative opioid use, postoperative adverse reactions, maternal satisfaction and impact on breastfeeding. Results: VAS scores in group S was significantly lower than those in group C at 1 day after operation. Immediately and 1 day after operation, the expression level of IL-6 in group S was lower than that in group C , while the expression level of IL-10 in group S was higher than that in group C (P < 0.05). There were no significant differences in adverse reactions, neonatal Apgar score, maternal satisfaction and breastfeeding (P > 0.05). Conclusion: Preoperative intravenous acetaminophen combined with PCEA can provide better postoperative pain management for parturients undergoing cesarean section than PCEA alone.