产科术后镇痛课件.ppt

产科术后镇痛*背景及目的临床资料与方法结果讨论不良反应发生情况PONV发生情况，虽雷莫司琼组恶心呕吐发生率较低，且II、III、IV级人数较少，但两组比较差异无统计学意义（P＜0.05）。PONV发生情况。A:术后恶心呕吐发生人数比例，B:PONV各程度级别人数。产科术后镇痛*2、PCEA：椎管内麻醉优点：比鞘内镇痛吗啡镇痛提供了更好少恶心和呕吐缺点性价比差影响活动药物阿片局麻药：浓度、个体差异等因素；比硬膜外单独应用阿片没有优势？阿片+局麻药产科术后镇痛*3、全身阿片类药物：全麻剖宫产全身阿片类药物对母乳喂养的新生儿相关报道不多

但理论上：当一种药物结合牛奶中的蛋白质或脂肪球上时，药物可能进入乳汁。脂溶性药物易在乳汁中（文献14）（文献1、4）英国人认为全身阿片对新生儿无影响产科术后镇痛250patientswhohadundergonesurgicalprocedures(in-andoutpatient)inthepastyearcompletedaquestionnaireabouttheirexperienceswithpainbeforeandaftersurgery.Themostcommonconcernthatpatientsexpressedpriortosurgerywasexperiencingpain(59%),whichwascitedmoreoftenthanconcernsaboutwhetherthesurgerywouldimprovetheircondition(51%)orwhethertheywouldfullyrecover(46%).58%ofthesamplereportedpainpriortosurgery.Despitereceivingtreatmentforpain,82%reportedpainintheimmediatepostsurgicalperiod(endofsurgeryupto2weeksafterdischarge)and75%reportedpainafterdischarge.Morethantwothirdsofpatientsreportedpainofmoderatetosevereintensity,andextremepainwasreportedby18%overalland8%afterdischarge.ApfelbaumJL,ChenC,MehtaSS,GanTJ.Postoperativepainexperience:resultsfromanationalsurveysuggestpostoperativepaincontinuestobeundermanaged.AnesthAnalg.2003;97:534-540.250patientswhohadundergonesurgicalprocedures(in-andoutpatient)inthepastyearcompletedaquestionnaireabouttheirexperienceswithpainbeforeandaftersurgery.Themostcommonconcernthatpatientsexpressedpriortosurgerywasexperiencingpain(59%),whichwascitedmoreoftenthanconcernsaboutwhetherthesurgerywouldimprovetheircondition(51%)orwhethertheywouldfullyrecover(46%).58%ofthesamplereportedpainpriortosurgery.Despitereceivingtreatmentforpain,82%reportedpainintheimmediatepostsurgicalperiod(endofsurgeryupto2weeksafterdischarge)and75%reportedpainaf