不同镇痛方法对剖宫产术后慢性疼痛的影响

Effect of different analgesia methods on chronic postoperative pain after cesarean section

摘要:

目的：比较剖宫产术后静脉自控镇痛（Patient controlled intravenous analgesia，PCIA）、硬膜外自控镇痛（Patient con－trolled epidural analgesia，PCEA）和肌肉注射镇痛药物（Muscle injection，MI）等3种方法对术后3月和6月慢性疼痛的影响。方法：150例在硬膜外麻醉下行择期剖宫产术的足月单胎初产妇随机分为3组（n=50）：PCIA组、PCEA组和MI组。PCIA组药液配方为10 mg/ml曲马多。参数设置：背景输注1 ml/h，单次按压剂量1 ml，锁定时间15 min。PCEA组药液配方为1.5 mg/ml罗哌卡因＋5 mg/ml曲马多。参数设置：背景输注2 ml/h，单次按压剂量1 ml，锁定时间15 min。MI组每隔12 h肌肉注射曲马多100 mg。3组术后镇痛维持48 h。分别记录术后4、12、24、36 h和48 h的（Visual analogue scale，VAS）评分；记录镇痛期间各组曲马多消耗量、补救药物使用及不良反应发生情况。随访患者术后3月和6月疼痛发生情况。结果：术后4、12 h和24 h的VAS评分PCEA组最低，PCIA组次之，MI组最高（P<0.05）；PCEA组3组患者术后36 h和48 h的VAS评分无统计学差异；镇痛期间MI组曲马多消耗量最低，PCEA组次之，PCIA组最高；PCEA组补救药物使用率低于其它2组，PCIA组又低于MI组（P<0.05）；PCEA组恶心呕吐发生率最低，PCIA组和MI组比较无明显差异。术后3月PCEA组慢性疼痛发生率最低（7.0%），PCIA组次之（11.1%），MI组最高（16.7%），PCEA组疼痛程度低于PCIA组和MI组，PCIA组又低于MI组（P<0.05）；术后6月各组慢性疼痛发生率较术后3月均下降，PCEA组为4.6%，PCIA组为6.7%，MI组为9.5%，各组疼痛程度比较差异无统计学意义。结论：PCEA是预防剖宫产术后慢性疼痛较好的镇痛方法。

Abstract:

Objective：To evaluate the effect of different analgesia methods on chronic postoperative pain after cesarean section. Methods：150 monomorphic primiparas scheduled for elective cesarean section under epidural anesthesia were enrolled and randomly assigned to receive 10 mg/ml tramadol through patient controlled intravenous analgesia（group PCIA，n=50），receive 1.5 mg/ml ropiva－caine plus 5 mg/ml tramadol through patient controlled epidural analgesia（group PCEA，n=50） and receive 100 mg tramadol by muscle injection per 12 hours （group MI，n=50）. Postoperative analgesia lasted 48 hours in each group. VAS scores，tramadol con－sumption，the events of requiring rescue analgesia as well as side effects such as nausea and vomiting during the first 48 hours follow－ing surgery were recorded. The incidence of chronic pain was observed at the third and sixth months after operation. Results：In the first 24 hours after operation，VAS score in group PCEA was significantly lower than in other groups，and group PCIA had lower VAS score than group MI. In the second 24 hours，VAS scores were equivalent among the 3 groups.The consumption of tramadol during analgesia period was the lowest in group MI and highest in group PCIA. The rate of requiring rescue analgesia was the lowest in group PCEA whereas highest in group MI. The occurrences of nausea and vomiting were similar in group MI and group PCIA，which were significantly higher than in group PCEA. The incidence rate of pain after operation was significantly lower in group PCEA than in other groups in the third and sixth months，and lower in group PCIA than in group MI at the same time. The pain intensity was lower in group PCEA than in group PCIA as well as group MI three months after operation. Conclusion：PCEA is a good alternative in pre－venting the development of chronic pain after cesarean section.