两种椎管内麻醉剖宫产术后PCEA的应用效果比较

发布时间：2018-11-20 13:05

【摘要】：目的:探讨蛛网膜下腔阻滞麻醉和硬膜外麻醉的剖宫产手术后PCEA的应用效果。方法:选取进行足月单胎剖宫产产妇60例,随机分为蛛网膜下腔阻滞麻醉组和硬膜外组,每组各30例。分别采用两种不同麻醉方式进行剖宫产,术后均连接PCEA,PCEA采用相同配方,总剂量为150 ml,术后两组均连接PCEA,总剂量控制在150 ml,镇痛药均为0.75%罗哌卡因30 ml,0.9%氯化钠注射液112 ml,芬太尼0.4 mg。观察两组产妇在术后2 h(T0)、4 h(T1)、8 h(T2)、12 h(T3)、24 h(T4)、48 h(T5)、72 h(T6)的活动和静息VAS情况和Blous次数,比较两组产妇的下床时间、肠排气时间、泌乳时间和不良反应发生情况。结果:两组产妇静息VAS评分结果显示,蛛网膜下腔阻滞麻醉组T1评分结果高于硬膜外组,T2、T3评分结果低于硬膜外组,差异有统计学意义(P0.05),活动VAS评分结果显示,蛛网膜下腔阻滞麻醉组T1评分结果高于硬膜外组,T2、T3、T4评分结果低于硬膜外组,差异有统计学意义(P0.05);蛛网膜下腔阻滞麻醉组T1Blous次数高于硬膜外组,T3、T4、T5Blous次数低于硬膜外组,差异有统计学意义(P0.05);两组产妇下床时间无统计学差异(P0.05);蛛网膜下腔阻滞麻醉组肠排气早于硬膜外组,差异有统计学意义(P0.05);蛛网膜下腔阻滞麻醉组泌乳时间早于硬膜外组,差异有统计学意义(P0.05)。蛛网膜下腔阻滞麻醉组瘙痒发生率、腰痛发生率均高于蛛网膜下腔阻滞麻醉组,差异有统计学意义(P0.05)。结论:蛛网膜下腔阻滞麻醉和硬膜外两种椎管内麻醉,在术后应用PCEA均安全有效,蛛网膜下腔阻滞麻醉剖宫产后应用PCEA的镇痛效果优于硬膜外麻醉剖宫产,蛛网膜下腔阻滞麻醉剖宫产后应用PCEA后产妇泌乳和肠排气恢复较早,并且不良反应发生率低。
[Abstract]:Objective: to investigate the effect of PCEA after cesarean section under subarachnoid block and epidural anesthesia. Methods: sixty pregnant women with term single fetal cesarean section were randomly divided into subarachnoid block anesthesia group and epidural anesthesia group with 30 cases in each group. Cesarean section was performed by two different anaesthesia methods. The same formula was used to connect PCEA,PCEA after operation. The total dose of PCEA, was controlled at 150 ml, and the total dose of ropivacaine was 0.75% ropivacaine 30 ml, in the two groups after operation. 0.9% sodium chloride injection 112 ml, fentanyl 0.4 mg. The activity, resting VAS and Blous times of 2 h (T 0), 4 h (T 1), 8 h (T 2), 12 h (T 3), 24 h (T 4), 48 h (T 5), 72 h (T 6) were observed in the two groups. Intestinal exhaust time, lactation time and adverse reactions. Results: the results of resting VAS score of two groups showed that the T1 score of subarachnoid block anesthesia group was higher than that of epidural anesthesia group, the T 2 T 3 score was lower than that of epidural group, the difference was statistically significant (P0.05). The activity VAS score showed that there was no significant difference between the two groups (P0.05). The T1 score of subarachnoid block group was higher than that of epidural group, and the score of T2T3T4 score was lower than that of epidural anesthesia group (P0.05). The number of T1Blous in subarachnoid block group was higher than that in epidural group, and the number of T3OT4T5Blous was lower than that in epidural group (P0.05), but there was no significant difference in the time of getting out of bed between the two groups (P0.05). The time of lactation in subarachnoid block group was earlier than that in epidural group (P0.05), and the difference was statistically significant (P0.05). The incidence of pruritus and low back pain in subarachnoid block group was higher than that in subarachnoid block group (P0.05). Conclusion: both subarachnoid block and epidural anesthesia are safe and effective in postoperative PCEA. The analgesic effect of PCEA after cesarean section with subarachnoid block is better than that with epidural anesthesia. After caesarean section with subarachnoid block anesthesia, lactation and intestinal exhaust recovered earlier, and the incidence of adverse reactions was low.
【作者单位】：延边大学医学院;
【分类号】：R614.3

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