目的:观察轨道式针外针行腰麻-硬膜外联合麻醉(CSEA)用于剖宫产术后自控硬膜外镇痛的临床效果.方法:选取94例剖宫产产妇,按照数表法将其随机分为观察组与对照组,每组47例.两组均采取CSEA联合产妇自控硬膜外镇痛(PCEA);观察组采用轨道式针外针行CSEA,对照组采用传统腰椎联合穿刺针行CSEA.比较两组术后1 h、4 h、12 h、24 h和48 h的疼痛视觉模拟量表(VAS)评分与Ramesay镇静评分,以及术后48 h内镇痛泵按压次数与镇痛泵所用药物剂量及不良反应发生情况.结果:两组术后1～12 h内,VAS评分均呈升高趋势,术后12～48 h两组疼痛VAS评分均逐渐降低,观察组和对照组术后1～12 h与术后12～48 h疼痛VAS评分比较,差异有统计学意义(F=29.596,F=156.366;P＜0.05);观察组术后4 h和12 h的疼痛VAS评分分别为(2.01±0.51)分和(3.49±0.74)分,低于对照组的(2.32±0.47)分和(3.85±0.69)分,两组比较差异有统计学意义(t=3.064,t=2.439;P＜0.05);两组术后1～48 h内,Ramesay镇静评分均未见较大波动,组间比较无统计学差异;观察组镇痛泵按压次数和镇痛泵所用药物剂量分别为(11.35±3.04)次和(65.67±7.98)ml,低于对照组的(20.08±5.32)次和(82.07±9.05)ml,两组比较差异有统计学意义(t=9.768,t=9.318;P＜0.05);观察组术后恶心和皮肤瘙痒发生率分别为4.26％和14.89％,低于对照组的17.02％和34.04％,两组比较差异有统计学意义(x2=4.029,x2=4.663;P＜0.05).结论:轨道式针外针行CSEA用于剖宫产手术比传统针内针法镇痛效果更佳,不良反应减少且安全有效.%Objective: To observe the clinical effect of combined spinal epidural anesthesia(CSEA)by using orbital needle in patient-controlled epidural analgesia(PCEA)post cesarean delivery.Methods: 94 puerperas who received cesarean were divided into observation group(47 cases)and control group(47 cases).The patients of two groups were narcotized by using CSEA combined with PCEA.And the observation group adopted a new type of lumbar vertebral combined puncture needle and the control group adopted the traditionally typical lumbar vertebral combined puncture needle.The score of visual analogue scale(VAS)and sedation score of Ramesay of two groups of postoperative 1h,4h,12h,24h and 48h were compared.And the number of times in 48h,the drug dosage and adverse reaction of using analgesia pump also were compared.Results: In postoperative 12 h,the VAS scores of the two groups showed an increasing trend.And the VAS scores of pain of two groups within postoperative 12-48 h decreased gradually.The differences of VAS scores of pain of two groups within postoperative 1-12h and 12-48h between observation group and control group were statistically significant(F=29.596,F=156.366,P＜0.05),respectively.And the VAS scores of pain post operative 4h and 12h of observation group [(2.01±0.51)and(3.49±0.74)]were significantly lower than that of control group [(2.32±0.47)and(3.85±0.69)](t=3.064,t=2.439,P＜0.05),respectively.Within postoperative 1-48h,there were no significant fluctuation in sedation score of Ramesay and the difference of sedation score between the two groups were no significant.And the number of times(11.35±3.04)and drug dosage(65.67± 7.98)mL of using analgesic pump of observation group were significantly lower than that of control group [(20.08±5.32)and(82.07 ± 9.05)mL],(t=9.768,t=9.318,P＜0.05),respectively.Besides,the incidences of postoperative nausea and skin pruritus of observation group(4.26％and 14.89％)were significantly lower than that of control group(17.02％and 34.04％)(x2=4.029,x2=4.663,P＜0.05),respectively.Conclusion: The analgesia effect of orbital needle external needle in implementing CSEA for cesarean delivery is better than that of traditional needle inner needle,and its adverse reactions are less and it is safety.
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