剖宫产术后硬膜外镇痛不同持续时间的镇痛效果比较

【目的】观察剖宫产术后硬膜外镇痛不同持续时间的镇痛效果。【方法】100例拟行剖宫产手术产妇，随机分为5组，每组20例。Ⅰ组：术后疼痛时肌肉注射盐酸哌替啶作为对照；Ⅱ组：手术结束前硬膜外单次注射负荷量吗啡1mg＋0．125％罗哌卡因5mL；Ⅲ组、Ⅳ组和Ⅴ组，在上述负荷量基础上，镇痛泵输注吗啡66．7μg／h＋0．125％盐酸罗哌卡因2mL／h，剂量分别为60mL、90mI。和150mL。于术后6h（T1）、12h（T2）、24h（T3）、48h（T4）、72h（T5）观察患者的疼痛视觉模拟评分（VAs），Ramsay镇静评分及不良反应。【结果】Ⅱ组VAS在T1、T2、T3、T4、T5各时点平均值为1．8、2．25、3．75、3．1和2．2，在T3、T4出现升高，与同时点Ⅴ组比较有显著性差异（P〈0．05），Ramsay镇静评分在各时点为3．05、2．25、1．3、1．7和2．1，在T3、T4出现下降，与同时点V组比较有显著性差异（P〈0．05）；Ⅲ组VAS在术后各时点为1．82、2．1、1．8、2．95、2．15，在T4出现升高，与同时点Ⅴ组比较有显著性差异（P〈0．05），Ramsay镇静评分在各时点为3．1、3．05、3．1、1．85和2．1，在T4出现下降，明显低于Ⅴ组（P〈0．05）；Ⅳ组各时点VAS分别为1．8、2．15、1．95、1．8、1．8，各时点均低于I组（P〈0．05），各时点的Ramsay镇静评分为3．15、3．2、3．1、3．5和2．5，各时点均高于Ⅰ组（P〈0．05）；Ⅴ组各时点VAS分别为1．8、2．1、1．95、1．75、1．3，各时点均低于Ⅰ组（P〈0．05），其中T5低于其他各组（P〈0．05），Ramsay镇静评分为3．2、3．05、3．1、3．15和2．5，各时点均高于Ⅰ组（P〈0．05）。各组副作用偶发，组间比较无显著性差异（P〉0．05）。【结论】延长剖宫产术后硬膜外镇痛持续时间，VAS和Ramsay镇静评分可持续维持在满意水平，术后72h镇痛效果最佳，患者更平稳、舒适。

Comparison of the Effects of Postoperative Analgesia with Different Duration after Caesarean Section

Objective] To observe the effects of epidural analgesia with different duration in the patients after caesarean section. Methods] One hundred parturients electively undergoing cesarean section under epidural block were randomly assigned into five groups with 20 cases for each. The patients in group were given conventional postoperative analgesia with meperidine injection, and those in groups Ⅱ were given loading dose of morphine ling plus 0. 125% ropivacaine hydrochloride 5 ml at the end of the operation. The pa- tients in groupⅢ ,group Ⅳ and group Ⅴ received epidural analgesia with 66.7μg/h of morphine and 2ml/h of 0. 125% ropivacaine hydrochloride on the basis of loading dose mentioned above. Their total amount was 60ml, 90ml and 150ml, respectively. The visual analog pain score（VAS ）, Ramsay sedative score and side effects were recorded and compared among five groups at 6h （T1）, 12h （T2）, 24h （T3）, 48h （T4） and 72h （T5） after operation. Results]The VAS in group Ⅲ at T1, T2, T3, T4 and T5 was i. 8, 2.25, 3.75, 3.1 and 2.2, and that at T3 and T4 was increased and significantly higher than that in groupV （ P d0. 05）. Ramsay sedative score at all time points was 3.05, 2.25, 1.3, 1.7 and 2.1, respectively, and that at T3 and T4 was decreased and significantly lower than that in groupV （ P 〈0.05）. In group Ⅲ, the VAS at all time points was 1.82, 2.1, 1.8, 2.95 and 2.15, and that at T4, the VAS was increased and significantly higher than that in groupV （ P 〈0.05）. The Ramsay sedative score at all time points was 3.1, 3.05, 3.1, 1.85 and 2. 1, respectively, and that at T4 was decreased and significantly lower than that in groupV（ P〈0. 05）. In group Ⅳ, the VAS at all time points was 1.8, 2.15, 1.95, 1.8 and 1.8, and there was significant difference between group Ⅳ and group Ⅰat the same time point（ P 〈0.05）, and the Ramsay sedative score was 3.15, 3.2, 3.1, 3.5 and 2.5, and significantly higher than that in group Ⅰat the same time points（ P 〈0.05）. In group Ⅴ, the VAS at all time points was 1.8, 2.1, 1.95, 1.75 and 1.3, and there was significant difference between group V and group Iat all time points（ P 〈0.05）, and lower than all other groups at T5 （ P〈 0. 05）. The Ramsay sedative score was 3.2, 3.05, 3.1, 3.15 and 2.5, respectively, and all higher than that in group Ⅰat all time points（ P 〈0. 05）. Occasional side effects of each group between the two groups showed no significant difference（ P 〉0. 05）. Conclusion] In the patients after caesarean section, extending the duration of epidural analgesia with morphine can maintain the satisfactory level of VAS and Ramsay sedative score. The analgesic effect with more than 72h after operation is best, and the patients feel more steady and comfortable.