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目的探讨剖宫产术后曲马多复合罗哌卡因用于硬膜外自控镇痛(PCEA)的效果和对血浆泌乳素(PRL)影响。方法随机将硬外麻醉下行剖宫产的100例足月健康产妇分为两组,各50例。观察组给予PCEA(曲马多5 mg/m L+0.125%罗哌卡因),对照组术后不行PCEA,在VAS评分≥5分时肌注杜冷丁50 mg镇痛,比较两组对PRL的影响和镇痛、镇静效果及不良反应发生情况。结果两组术前血浆PRL浓度无差异(P>0.05),术后均较术前显著升高(P<0.01),观察组术后24 h、48 h血浆PRL浓度均明显高于对照组,差异有统计学意义(P<0.01);观察组VAS评分优于对照组,差异有统计学意义(P<0.05);观察组镇静评分明显高于对照组(P<0.05),差异有统计学意义;恶心、呕吐、皮肤瘙痒等不良反应两组比较,P>0.05,差异无统计学意义。结论剖宫产术后采用曲马多复合罗哌卡因行PCEA,镇疼效果良好,可促进PRL的分泌及早泌乳且不良反应较少,适合剖宫产术后镇痛。
Objective To investigate the effect of tramadol combined with ropivacaine for epidural analgesia (PCEA) after cesarean section and its effect on plasma prolactin (PRL). Methods 100 full-term healthy pregnant women who underwent extra-corporeal anesthesia with cesarean section were divided into two groups, 50 cases each. The observation group was given PCEA (tramadol 5 mg / m L + 0.125% ropivacaine), while the control group was given no PCEA after operation. When the VAS score was ≥5, 50 mg of pethidine was administered intramuscularly. The impact and analgesic, sedative effects and adverse reactions. Results There was no significant difference in preoperative PRL concentration between the two groups (P> 0.05), and the postoperative PRL concentration was significantly higher than that before operation (P <0.01). The plasma PRL concentrations in the observation group at 24 h and 48 h after operation were significantly higher than those in the control group (P <0.01). The VAS score of the observation group was superior to that of the control group (P <0.05), the sedation score of the observation group was significantly higher than that of the control group (P <0.05), the difference was statistically significant Significance; nausea, vomiting, skin itching and other adverse reactions in both groups, P> 0.05, the difference was not statistically significant. Conclusions Tramadol and ropivacaine combined with PCEA after cesarean section is effective in relieving pain. It can promote the secretion of PRL with early lactation with fewer adverse reactions and is suitable for analgesia after cesarean section.