剖腹產病人使用不同處方行自控式疼痛控制術後止痛之比較

Comparison of Different Regimens in Cesarean Section (C/S) Patients Receiving PCA Services during Postoperative Period

研究目的：研究剖腹產病人，在使用不同處方自控式疼痛控制其止痛效果及副作用的比較。方法：以亞培病患自控式輸液幫浦，用於術後止痛的產科病人，採用以四種不同處方及注射位置：（1）靜脈技與嗎啡自控式疼痛控制，（2）腰椎硬脊膜外腔投與嗎啡自控式疼痛控制，（3）腰椎硬脊膜外腔技與局部麻醉藥－麻佳因（0.0625的自控式疼痛控制，（4）腰椎硬脊膜外腔技與局部麻醉藥－麻佳因（0.0625克）及嗎啡自控式疼痛控制。並同時以滿意度（PRS）及疼痛指標（VAS）做為評估疼痛控制指標，評估術後二十四、四十八、七十二小時，病人每個時段休息、活動及咳嗽時的滿意度及疼痛指標。並計算嗎啡的使用總量及相關副作用，如頭暈、嘔吐、皮膚癢、鎮靜及對四肢運動的影響。結果：目前初步所收集的數據，第一組n值為30，第二組n值為41，第三組n值為63第四組n值為62，由目前所收集的結果發現，其中硬脊膜外腔麻佳因（0.0625%）及嗎啡，滿意度可達3-4分，且所引起之相關副作用，如頭暈（4.55%）、嘔吐（1.55%）、皮膚癢（9.55%）等最少，但單純只由硬脊膜外腔技與麻佳因（0.0625%），滿意度較差，且病人自控所按次數比例為最高，表示止痛效果差。若單純給予嗎啡其滿意度可達3分，但所造成頭暈（10.5%）、嘔吐（20.5%）的副作用較其他兩組嚴重。結論：經由以上結果已初步發現，自控式疼痛控制對於控制術後止痛效果相當不錯，其中以第四組腰椎硬脊膜外腔技與局部麻醉藥一麻佳因（0.0625%）及嗎啡自控式疼痛控制的效果為最佳。且使用不同處方對於產科病人術後止痛，確實有不同的反應與結果。

Aim of investigation : The present study is designed to evaluate the efficacy and side effects of different regimens in Cesarean Section (C/S) patients receiving Patient Controlled Analgesia (PCA) services during postoperative period. Methods: C/S patients receiving postoperative analgesia were used Aim plus (Abbott Loboratories) with four different regimens. These regimens included (1) intravenous PCA with morphine, (2) epidural PCA with morphine, (3) epidural PCA with 0.0625% marcaine only and (4) epidural PCA with morphine and 0.0625% marcaine. Pain was assessed using a Visual Analogue Score (VAS) and a degree of Pain Relief Scale (PRS) for rest, movement and cough, daily every 24 hrs. At the same time, we evaluated the total amount of morphine and the side effects such as nausea, vomiting, pruritis, sedation and motor block. Results : These results indicated that the treatment of epidural PCA with morphine and 0.0625% marcaine had the highest score of PRS (3-4), the best pain relief and least side effects such as nausea (4.55%), vomiting (1.55%) and pruritis (9.5%). The patient receiving only epidural 0.0625% marcaine had the lowest PRS value and higher bolus demand numbers. It was expressed that this regimen had the least pain relief efficacy. On the other hand, receiving epidural PCA only with morphine had good pain relief effects but more serious side effects like nausea (17.5 %), vomiting (15 %). Conclusions : PCA has been shown to be both safe and effective in the control of postoperative pain in C/S patients. In this study, epidural PCA with morphine and 0.0625% marcaine is better than any other regimen in C/S patients receiving PCA services, and indeed have different efficacy in four different regimens.