硬膜外泵入布托啡诺复合小剂量氯胺酮在分娩镇痛中的应用  

Epidural in fasion butorphanol plus low dose of ketamine in labor analgesia

作　　者：邓燕[1] 张勇 王开祥[1] 

机构地区：[1]山东省滕州市中心人民医院麻醉科,277500 [2]山东省枣庄市王开传染病医院

出　　处：《中国实用医刊》2009年第23期30-31,共2页Chinese Journal of Practical Medicine

摘　　要：目的观察硬膜外持续泵入布托啡诺复合小剂量氯胺酮用于分娩镇痛的效果及其对分娩过程和胎儿的影响。方法选择单胎足月初产妇60例，随机分为两组。A组（对照组）30例，硬膜外持续泵入0．1％罗哌卡因＋芬太尼0．15μg／ml，泵速4ml／h；B组（观察组）30例，硬膜外持续泵入布托啡诺0．1mg/kg＋氯胺酮0．7mg／kg，泵速4ml／h。连续监测呼吸，循环情况；采用视觉模拟疼痛评分（VAS）评估镇痛效应；运动神经阻滞程度按改良的Bromage标准进行测定；观察记录产程进展宫缩及胎儿情况、新生儿情况及不良反应。结果A、B两组的VAS评分差异无统计学意义（P〉0．05）。新生儿各时点的Apgar评分两组间比较差异也无统计学意义（P〉0．05）。A组第二产程（67±51）min，较B组（41±20）min有所延长（P〈0．05）。产妇的生命体征、宫缩、胎儿及运动神经阻滞程度，两组差异无统计学意义。结论硬膜外泵入布托啡诺复合小剂量氨胺酮可安全有效地应用于分娩镇痛。Objective To evaluate the analgesic efficacy and safety of butorphanol combined with low dose of ketamine for labor analgesia. Methods Sixty ASA Ⅰ- Ⅱ full term primigravidae in active labor who had a single fetus with vertex presentation and were expected to have avaginal deavery were randomly divided into two groups;control group （group A） received with ropicanine and fentany （ n =30） ;observation group （group B） received with butorphanol 0.1 mg/kg in combination with ketamie 0. 7 mg/kg in 100 ml normal saline. Both infusion in a rate of 4 ml/h. The intensity of pain was evaluated by patients using VAS and motor function was assessed using modified bromage score. The vital signs （BP, HR, SpO2 ）, fetal neart rate,labor process, mode of delivery. Apgar score of neonates and side effects of analgesia were recorded. Results There was no significant differece in VAS score and fetal apgar score between group A and B（ P 〉0. 05） ;the duration of second stage of labor was longer in group A [ （ 67 ± 51 ） min ] than that in group B [ （ 44 ± 21 ） min ], P 〈 0.05. There were signficant differences in vital signs, fetal heare rate, degree of motor block and uterine contraction between the two groups. Conclusions Butorphanol in continuous epidaral infusion in combination with low dose of ketamine is effective in labor analgesia.

关 键 词：产科 硬膜外 镇痛 氯胺酮 布托啡诺 

分 类 号：R614[医药卫生—麻醉学]