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| 硬膜外注射吗啡用于缓解侧切产妇产后会阴部疼痛的效果 |
| Efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy |
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| DOI： |
| 中文关键词: 吗啡 侧切 会阴部疼痛 有效性 |
| 英文关键词: Morphine Episiotomy Perineal pain Efficacy |
| 基金项目:南京医科大学科技发展基金面上项目(2014NJMU091);江苏省科技厅临床医学专项项目(BL2014016) |
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| 中文摘要: |
目的 观察硬膜外注射吗啡缓解侧切产妇产后会阴部疼痛的有效性。
方法 选择要求自然分娩且经历侧切的产妇145例，随机分为三组，脐带结扎后硬膜外分别给予内含1 mg吗啡(M1组)或2 mg吗啡(M2组)的生理盐水10 ml，或单纯生理盐水10 ml(C组)。随访记录产妇产后24 h内静息和活动状态现实疼痛强度(present pain intensity， PPI)及活动时PPI中重度疼痛出现时间；同时记录吗啡相关不良反应。
结果 静息状态PPI中重度疼痛的比例M2组(2.1％)明显低于M1组(15.7％)和C组(19.1％)(P<0.05)；活动状态PPI中重度疼痛出现时间M2组(15.7±1.4)h明显晚于M1组(11.0±0.9)h和C组(11.0±1.0)h(P<0.05)。然而，恶心、呕吐、瘙痒、尿潴留的累积发生率M2组(102.1％)明显高于M1组(43.1％)和C组(12.8％)(P<0.05)。
结论 脐带结扎后硬膜外注射2 mg吗啡虽然显著减低产妇静息PPI中重度疼痛的比例并推迟活动时PPI中重度疼痛的出现时间，但是增加了不良反应发生率，需慎重使用。 |
| 英文摘要: |
Objective To observe the analgesic efficacy of epidural morphine for postpartum perineal pain in patients undergoing episiotomy.
Methods After institutional reviewing board approval and patient consent, a total of 145 parturients requesting epidural labor analgesia and undergoing episiotomy were randomized into three groups: M1, M2, and C, where in morphine 1 mg dissolved in saline 10 ml, morphine 2 mg dissolved in saline 10 ml, or sole saline 10 ml was epidurally given immediately after umbilical cord clamp, respectively. Perineal pain at rest and movement within 24 hours after vaginal delivery were evaluated with present painintensity (PPI). Further, the time interval between a moderate or severe PPI and epidural drug treatment were recorded. Besides, epidural morphine related side effects including nausea, vomiting, pruritus, and urinary retention were observed as well.
Results The proportion of patients with moderate or severe painat rest was significantly lower in group M2 (2.1％) compared to group M1 (15.7) and group C (19.1％) (P<0.05). Further, the time interval between a moderate or severe PPI and epidural drug treatment was significantly longer in group M2 (15.7±1.4 h) compared to group M1 (11.0±0.9 h) and group C (11.0±1.0 h)(P<0.05). No significant difference was found between groups M1 and group C with regard to morphine efficacy. However, the accumulated side effects including nausea, vomiting, pruritus, and urinary retention prominently increased in group M2 (102.1％)compared to group M1 (43.1％) and group C (12.8％) (P<0.05).
Conclusion Although epidural morphine 2 mg may significantly decrease and postpone the occurrence of moderate or severe postpartum perineal pain, however, it deserves consideration before clinical use owing to the increased side effects. |
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