两种椎管内麻醉剖宫产术后 PCEA 的应用效果比较

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（P ＜0.05），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（P ＜0.05）；蛛网膜下腔阻滞麻醉组 T1Blous 次数高于硬膜外组，T3、T4、T5 Blous 次数低于硬膜外组，差异有统计学意义（P ＜0.05）；两组产妇下床时间无统计学差异（P ＞0.05）；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（P ＜0.05）；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（P ＜0.05）。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（P ＜0.05）。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。%Objective To investigate the application effect of PCEA after cesarean section in the anesthesia of subara block an-esthesia and spinal anesthesia.Method 60 cases of cesarean section were selected and randomly divided into spinal anesthesia group and epidural group.30 cases in each group.Two different ways of anesthesia for cesarean section and postoperative PCEA. PCEA used the same formula,total dose of 150 ml,after operation in the two groups were with PCEA and total dose control in 150 ml,analgesics were 0.75% ropivacaine 30 ml and 0.9% sodium chloride injection oil -free,fentanyl 0.4 mg were used respective-ly.The women in the two groups in postoperative (T0 )2 h,4 h (T1 ),8 (T2 ),12 h (T3 ),24 h (T4 )and 48 h (T5 )and 72 h (T6 ) activities and resting vas and Blous times and compared between the two groups of women out of bed time,intestinal exhaust time, the time of lactation and adverse reactions occurred condition were observed.Results Below the number of,more than the number of group was lower than that of the results of the two groups of mothers resting.VAS score results showed that spinal anesthesia group T1 score was higher than those in the epidural group,T2 ,T3 score epidural group (P <0.05),VAS score results showed that spinal anesthesia T1 score was higher than those in the epidural group,T2 ,T3 ,T4 score epidural group (P <0.05);0.05;spinal anesthesia T1 Blous the dura mater group and T3 ,T4 T5 Blous the dura mater group (P <0.05);two groups of maternal bed time had no signifi-cant difference (P <0.05);spinal anesthesia group of intestinal gas early in the epidural group (P <0.05);spinal anesthesia groups of lactating time earlier than the hard membrane group (P <0.05).Spinal anesthesia group pruritus incidence was higher than that of epidural group (P <0.05),epidural group the incidence of low back pain than spinal anesthesia group (P <0.05) .Conclusion Spinal anesthesia and epidural two intraspinal anesthesia in postoperative PCEA are safe and effective,and spinal an-esthesia for cesarean section postpartum PCEA analgesia effect is better than that of epidural anesthesia Caesarean birth,spinal an-esthesia for cesarean section postpartum PCEA after lactation and maternal intestinal gas recovered earlier,and adverse reaction rate is low.