[1]卡地尔丁·艾海提,叶建荣.吗啡不同给药时机对硬膜外麻醉下行剖宫产术患者的麻醉效果及术后镇痛效果的影响[J].医学信息,2022,35(16):51-54108.[doi:10.3969/j.issn.1006-1959.2022.16.011]
　KADIERDING·AIHAITI,YE Jian-rong.Effects of Different Administration Time of Morphine on Anesthesia and Postoperative Analgesia in Patients Undergoing Cesarean Section Under Epidural Anesthesia[J].Journal of Medical Information,2022,35(16):51-54108.[doi:10.3969/j.issn.1006-1959.2022.16.011]
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吗啡不同给药时机对硬膜外麻醉下行剖宫产术患者的麻醉效果及术后镇痛效果的影响()
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医学信息[ISSN:1006-1959/CN:61-1278/R]

卷:
35卷
期数:
2022年16期
页码:
51-54108
栏目:
论著
出版日期:
2022-08-15

文章信息/Info

Title:
Effects of Different Administration Time of Morphine on Anesthesia and Postoperative Analgesia in Patients Undergoing Cesarean Section Under Epidural Anesthesia
文章编号:
1006-1959（2022）16-0051-05
作者:
卡地尔丁·艾海提; 叶建荣
（新疆医科大学第一附属医院麻醉科，新疆 乌鲁木齐 830011）
Author(s):
KADIERDING·AIHAITI; YE Jian-rong
(Department of Anesthesiology,the First Affiliated Hospital of Xinjiang Medical University,Urumqi 830011,Xinjiang,China)
关键词:
剖宫产术; 硬膜外麻醉; 吗啡; 术后镇痛; 肌松效果; 腹膜牵拉反应
Keywords:
Cesarean section; Epidural anesthesia; Morphine; Postoperative analgesia; Muscle relaxation effect; Peritoneal traction reaction
分类号:
R614
DOI:
10.3969/j.issn.1006-1959.2022.16.011
文献标志码:
A
摘要:
目的 观察吗啡不同给药时机对硬膜外麻醉行剖宫产手术的麻醉效果、术后镇痛效果及术中术后短期并发症的影响，探索吗啡的最佳给药时机。方法 选取2018年1月-2019年8月在我院行剖宫产术的产妇240例，随机分为A、B、C三组，各80例。A组经硬膜外导管注入1%盐酸罗哌卡因注射液10 ml+0.9%氯化钠注射液1 ml；B组经硬膜外导管注入1%盐酸罗哌卡因注射液10 ml+0.2%盐酸吗啡注射液1 ml；C组经硬膜外导管注入1%盐酸罗哌卡因注射液10 ml，手术结束关腹后经硬膜外导管注入0.2%盐酸吗啡注射液1 ml。比较三组感觉阻滞及运动阻滞起效时间，感觉阻滞达到高峰时间，改良Bromage评分，麻醉效果评分，肌松效果评分，缝合子宫时（T1）、探查附件级腹腔时（T2）及缝合腹膜时（T3）腹膜牵拉反应、无创血压及心率，新生儿出生后1 min及5 min的Apgar评分，术后各时间点（2、6、12、24 h）切口和宫缩疼痛（VAS）评分、BCS舒适度评分及不良反应。结果 B组感觉阻滞起效时间、感觉阻滞达到高峰时间、运动阻滞起效时间均快于A组与C组，麻醉效果和肌松效果评分优于A组与C组，T1、T2、T3时腹膜牵拉反应轻于A组与C组，差异均有统计学意义（P＜0.05）；T2、T3时A组与C组血压高于B组，心率快于B组，差异有统计学意义（P＜0.05）；B组与C组术后6、12、24 h切口VAS评分和术后2、6、12、24 h宫缩VAS评分均低于A组，术后6、12、24 h BCS舒适度评分均高于A组，差异均有统计学意义（P＜0.05）；三组改良Bromage评分、术后2 h切口VAS评分和BCS舒适度评分、新生儿出生后1、5 min Apgar评分、不良反应发生率比较，差异无统计学意义（P＞0.05）。结论 剖宫产手术前硬膜外给予吗啡可以加快麻醉起效时间，增强麻醉及肌松效果，降低腹膜牵拉反应，同时还有良好的术后镇痛效果，不良反应发生率低，安全性良好。
Abstract:
Objective To observe the effects of different administration time of morphine on anesthesia effect, postoperative analgesia effect and short-term complications during and after cesarean section under epidural anesthesia, and to explore the best administration time of morphine.Methods A total of 240 parturients who underwent cesarean section in our hospital from January 2018 to August 2019 were randomly divided into groups A, B and C, with 80 cases in each group. In group A, 1% ropivacaine hydrochloride injection 10 ml+0.9% sodium chloride injection 1 ml was injected through epidural catheter; group B was injected with 1% ropivacaine hydrochloride injection 10 ml+0.2% morphine hydrochloride injection 1 ml through epidural catheter; and in group C, 10 ml of 1% ropivacaine hydrochloride injection was injected through epidural catheter, and 1 ml of 0. % morphine hydrochloride injection was injected through epidural catheter after abdominal closure. The onset time of sensory block and motor block, the peak time of sensory block, modified Bromage score, anesthesia effect score, muscle relaxation effect score, peritoneal traction reaction, non-invasive blood pressure and heart rate at the time of suture of uterus (T1), exploration of accessory abdominal cavity (T2) and suture of peritoneum (T3), Apgar score at 1 min and 5 min after birth, incision and uterine contraction pain (VAS) score at each time point (2, 6, 12, 24 h), BCS comfort score and adverse reactions were compared among the three groups.Results The onset time of sensory block, the peak time of sensory block and the onset time of motor block in group B were faster than those in group A and group C, the scores of anesthesia effect and muscle relaxation effect were better than those in group A and group C, and the peritoneal traction reaction at T1, T2 and T3 was lighter than that in group A and group C, the differences were statistically significant (P<0.05). At T2 and T3, the blood pressure of group A and group C was higher than that of group B, and the heart rate was faster than that of group B (P<0.05). The VAS scores of incision at 6,12 and 24 h after operation and the VAS scores of uterine contraction at 2,6,12 and 24 h after operation in group B and group C were lower than those in group A, and the BCS comfort scores at 6,12 and 24 h after operation were higher than those in group A, the differences were statistically significant (P<0.05). There was no significant difference in modified Bromage score, incision VAS score and BCS comfort score at 2 h after operation, Apgar score at 1 and 5 min after birth and incidence of adverse reactions among the three groups (P>0.05).Conclusion Epidural administration of morphine before cesarean section can accelerate the onset time of anesthesia, enhance the effect of anesthesia and muscle relaxation, reduce peritoneal traction reaction, as well as with good postoperative analgesic effect, low incidence of adverse reactions, good safety.

参考文献/References:

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更新日期/Last Update: 1900-01-01