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剖宫产术后患者自控硬膜外注射哌替啶与护士给药硬膜外注射哌替啶用于镇痛的比较。

A comparison of patient-controlled epidural pethidine vs. nurse-administered epidural pethidine for analgesia after caesarean section.

作者信息

Lim Yvonne, Wilson Sally, Katz Steven

机构信息

Department of Anaesthesia, KK Women's and Children's Hospital, Singapore.

出版信息

J Opioid Manag. 2006 Mar-Apr;2(2):99-104. doi: 10.5055/jom.2006.0016.

Abstract

Patient-controlled epidural analgesia with pethidine for post-caesarean section patients has been shown to be efficacious. However, no studies to date have compared it with intermittent nurse-administered epiduralpethidine. The aim of this study was to compare the analgesia efficacy, pethidine requirement, side effects, and nurses' and patients' satisfaction with these two techniques in post-caesarean section patients. After obtaining informed patient consent, we recruited 34 patients undergoing elective lower-segment caesarean section. A combined spinal epidural technique was used to provide anesthesia for all patients, and 50 mg pethidine was given epidurally at the end of the operation. Patients were assigned to two groups: group P (n = 17) received patient-controlled epidural analgesia with pethidine (25 mg of five mg/ml solution, lockout of 10 minutes and maximum dose of 150 mg/four hours), and group N (n = 17) received nurse-administered epiduralpethidine (bolus of 50 mg and maximum dose of 50 mg/two hours) when required. We collected data at six, 12, 24, 36, and 48 hours following initiation of anesthesia. Visual analogue pain scores (median) were lower in group P than in group N, both on movement and at rest, at six, 12, 24, 36, and 48 hours postoperatively (p < 0.05). Total pethidine consumption (median) and frequency of side effects were similar in both groups. Patients in group P exhibited a trend toward earlier return to activities of daily living and care for the newborn; however, this did not reach statistical significance, and there was no difference in maternal satisfaction between the two groups. Satisfaction scores of nurses caring for patients in group P were higher than for those in group N (median 100 mm, interquartile range [IQR] 90 to 100, vs. median 90 mm, IQR 80 to 90, p < 0.05). Patient-controlled epidural analgesia with pethidine improved patients' pain scores after caesarean section when compared with intermittent nurse-administered epiduralpethidine. Regarding the mode of delivery of postoperative analgesia, we noted a higher satisfaction score among nurses caring for group P than among those caring for group N.

摘要

已证明,剖宫产术后患者使用哌替啶自控硬膜外镇痛是有效的。然而,迄今为止尚无研究将其与护士间断给予硬膜外哌替啶进行比较。本研究的目的是比较这两种技术用于剖宫产术后患者的镇痛效果、哌替啶需求量、副作用以及护士和患者的满意度。在获得患者知情同意后,我们招募了34例行择期下段剖宫产术的患者。所有患者均采用腰麻 - 硬膜外联合技术进行麻醉,手术结束时硬膜外给予50 mg哌替啶。患者被分为两组:P组(n = 17)接受哌替啶自控硬膜外镇痛(25 mg,5 mg/ml溶液,锁定时间10分钟,最大剂量150 mg/4小时),N组(n = 17)必要时接受护士给予的硬膜外哌替啶(单次推注50 mg,最大剂量50 mg/2小时)。我们在麻醉开始后6、12、24、36和48小时收集数据。术后6、12、24、36和48小时,P组在活动和静息时的视觉模拟疼痛评分(中位数)均低于N组(p < 0.05)。两组的哌替啶总消耗量(中位数)和副作用发生率相似。P组患者在恢复日常生活活动和照顾新生儿方面有较早恢复的趋势;然而,这未达到统计学意义,两组产妇的满意度也无差异。护理P组患者的护士满意度评分高于护理N组患者(中位数100 mm,四分位间距[IQR] 90至100,对比中位数90 mm,IQR 80至90,p < 0.05)。与护士间断给予硬膜外哌替啶相比,哌替啶自控硬膜外镇痛改善了剖宫产术后患者的疼痛评分。关于术后镇痛的给药方式,我们注意到护理P组患者的护士满意度评分高于护理N组患者。

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