【摘要】 目的 探讨平衡镇痛用于剖宫产手术的术后镇痛优势以及获得标准化类似临床路径的优良镇痛方案，以便更好地服务临床工作。方法 选择在椎管内麻醉下行剖宫产手术的90例患者，根据术后镇痛治疗方式不同分为A组（静脉自控镇痛）、B组（连续硬膜外镇痛）、C组（吗啡单次硬膜外镇痛联合静脉自控镇痛），每组30例。记录并比较三组的手术相关指标、疼痛情况、硬膜外麻醉效果消失时间、舒适度以及不良反应。结果三组的手术时长以及出血量无显著差异（P>0.05）。C组术后6、12、24 h的视觉模拟评分法（VAS）评分低于A组和B组（P<0.05）;B组术后6、12、24 h的VAS评分低于A组（P<0.05）。三组的硬膜外麻醉效果消失时间无显著差异（P=0.256）。C组术后6、12、24 h的舒适度评分（BCS）评分高于A组和B组（P<0.05）;B组术后6、12 h的BCS评分高于A组（P<0.05）;A组和B组术后24 h的BCS评分无显著差异（P>0.05）。C组发生不良反应的例数少于A组和B组，B组发生不良反应的例数少于A组；三组的不良反应总发生率比较，差异具有统计学意义（P<0.05）。结论 剖宫产术后行吗啡单次硬膜外镇痛联合静脉自控镇痛的效果确切，且不良反应发生率低，患者舒适度高。更多还原

【Abstract】 Objective To explore the advantages of balanced analgesia for postoperative analgesia in cesarean section and to obtain an excellent analgesia scheme similar to standardized clinical pathway, so as to better serve clinical work. Methods A total of 90 patients undergoing cesarean section under spinal anesthesia were selected and divided into group A(patient-controlled intravenous analgesia), group B(continuous epidural analgesia) and group C(morphine single epidural analgesia combined with patient-controlled intravenous analgesia) according to the different treatment methods of postoperative analgesia, with 30 cases in each group. The operation related indexes, pain, disappearance time of epidural anesthesia effect, comfort and adverse reactions of the three groups were recorded and compared. Results There were no significant differences in operation time and bleeding volume among the three groups(P>0.05). The Visual Analogue Scale(VAS) score of the group C at 6, 12 and 24 h after operation was lower than that of the group A and the group B(P<0.05);the VAS score of the group B at 6, 12 and 24 h after operation was lower than that of the group A(P<0.05).There was no significant difference in the disappearance time of epidural anesthesia effect among the three groups(P=0.256). The Bruggrmann Comfort Scale(BCS) score at 6, 12 and 24 h after operation in the group C was higher than that in the group A and the group B(P<0.05); the BCS score at 6 and 12 h after operation in the group B was higher than that in the group A(P<0.05); there was no significant difference in BCS score between the group A and the group B at 24 h after operation(P>0.05). The cases of adverse reactions in the group C was less than that in the group A and the group B, and the cases of adverse reactions in the group B was less than that in the group A; there was a significant difference in the total incidence of adverse reactions among the three groups(P<0.05). Conclusion Morphine single epidural analgesia combined with patient-controlled intravenous analgesia after cesarean section has a definite effect, with fewer incidence of adverse reactions and high patients’ comfort.更多还原