剖宫产术后硬脊膜外腔芬太尼负荷剂量的容积对镇痛的影响

发布时间：2018-03-18 09:10

本文选题：负荷剂量　切入点：容积　出处：《上海医学》2015年04期 　论文类型：期刊论文

【摘要】：目的探讨在蛛网膜下腔阻滞联合硬脊膜外腔阻滞麻醉(CSEA)下行剖宫产术产妇术后经硬脊膜外腔导管注射相同剂量、不同容量芬太尼对患者自控硬脊膜外腔镇痛(PCEA)效果的影响。方法选择单胎足月妊娠在CSEA下行子宫下段剖宫产术的产妇100例,美国麻醉医师协会(ASA)分级Ⅰ或Ⅱ级,随机分入5mL组和1mL组,每组50例。两组在施行PCEA前的麻醉处理相同,在接硬脊膜外腔镇痛泵前经硬脊膜外腔导管注入负荷剂量的芬太尼均为25μg,5mL组的容量为5mL,1mL组的容量为1mL,然后接入配方、容量和注射速度均相同的镇痛泵。在术后1h(T0)、4h(T1)、8h(T2)、12h(T3)、24h(T4)、48h(T5)各时间点,记录疼痛视觉模拟评分(VAS评分)、Ramsay镇静评分。记录产妇术后48h内PCEA有效按压总次数、曲马多用量、不良反应和住院时间,并对镇痛满意度进行综合评价。结果两组间T0时间点的疼痛VAS评分和Ramsay镇静评分的差异均无统计学意义(P值均0.05);1mL组T1至T5各时间点的疼痛VAS评分均显著高于5mL组同时间点(P值均0.05),Ramsay镇静评分均显著低于5mL组同时间点(P值均0.05)。5mL组产妇的镇痛满意率显著高于1mL组(P0.05),不满意率显著低于1mL组(P0.05)。5mL组的PCEA泵按压次数和曲马多用量均显著少于1mL组(P值均0.05)。5mL组的不良反应发生率显著低于1mL组(P0.05)。结论硬脊膜外腔注射同样剂量芬太尼作负荷量时,5mL容积优于1mL,有助于提高镇痛效果。
[Abstract]:Objective to explore the same dose of epidural catheterization after cesarean section under subarachnoid block combined with epidural block anesthesia (CSEAA). Effect of fentanyl of different volume on patient-controlled epidural analgesia (PCEA). Methods 100 cases of parturient undergoing CSEA lower segment cesarean section were selected. They were randomly divided into 5 mL group and 1 mL group with 50 cases in each group. The anesthetic treatment before PCEA was the same in both groups. The loading dose of fentanyl injected through epidural cavity catheter before epidural analgesia pump was 25 渭 g / 5 mL. The volume of fentanyl in 5 mL group was 1 mL, and then the analgesic pump with the same formula, capacity and injection rate was inserted. At 1 hour after operation, the dose of fentanyl was 12 h, and the dose of fentanyl was 12 h, and the volume of fentanyl was 24 h / L and the volume of injection was the same as that of injection rate. The visual analogue score of pain and visual analogue score and Ramsay sedation score were recorded. The total number of effective PCEA compressions, tramadol dosage, adverse reactions and hospitalization time were recorded within 48 hours after operation. Results there was no significant difference in pain VAS score and Ramsay sedation score between the two groups at T0 time point. Results the pain VAS scores of T1 to T5 groups were significantly higher than those of 5 mL group. At the same time point, the P value of Ramsay was significantly lower than that of the group of 5 mL at the same time. The satisfaction rate of analgesia of parturient in group P was significantly higher than that in group 1 mL, and the unsatisfactory rate was significantly lower than that in group 1 mL of PCEA pump pressing times and the dosage of tramadol in group P0.05. 5 mL. The incidence of adverse reactions in the group with less than 1 mL of fentanyl was significantly lower than that in the group of 1 mL. Conclusion the volume of 5 mL of fentanyl is better than 1 mL when the same dose of fentanyl is injected into the epidural cavity, which is helpful to improve the analgesic effect.
【作者单位】：邳州市东大医院麻醉科;南京医科大学第一附属医院麻醉科;
【分类号】：R614

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