阿片类药物硬膜外术后镇痛对产妇血清髓鞘碱性蛋白和下肢体感诱发电位的影响  

Effect of patient-controlled epidural analgesia with opioids on serous myelin basic protein and somatosensory evoked potential of lower limbs in puerperants

作　　者：宋杰[1] 杜伯祥[1] 崔志明[2] 周峰[3] 杨许丽[1] 保国峰[2] 刘麟[1] 

机构地区：[1]南通大学第二附属医院麻醉科,南通市226001 [2]南通大学第二附属医院脊柱外科,南通市226001 [3]南通大学第二附属医院检验科,南通市226001

出　　处：《中华行为医学与脑科学杂志》2011年第11期1008-1011,共4页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：江苏省卫生厅医学科研招标立项课题（H200854）

摘　　要：目的观察阿片类药物用于剖宫产硬膜外水后自控锁痛（Pafient-controlled epidmal analgesia，PCEA）对血清髓鞘碱性蛋白（myelin basic protein，MBP）和下肢体感诱发电位（somatosensory evoked potential，SEP）的影响。方法术话行PCEA的剖宫产产妇120例，随机数字表法分为4组，每组30例：B组：0．008％布托啡诺；BR组：0．008％布托啡诺＋0．2％罗哌卡因；MR组0．004％吗啡＋0．2％罗哌卡因；R组：0．2％罗哌卡因，观察记录孕妇术后2h（T1）、4h（T2）、8h（T3）、12h（T4）、24h（T5）和48h（T6）的VAS评分、OAA／S评分、不良反应发生情况、血清MBP浓发、下肢SEP和神经功能结果T3、T4、T5时点的VAS评分，BR组[（1．64±0．38）分，（1．86±0．62）分，（1．93±0．67）分[和MR组（1．74±0．39）分，（1．91±0．58）分，（1．98±0．63）分]均低于B组（4．6±0．5）分，（4．6±0．3）分。（4．7±0．3）分]和R组（2．64±0．41）分，（2．83±0．91）分，（3．37±0．87）分（P〈0．05）]；各组各时点的OAA／S评分无差异（P〉0．05）；MR组的恶心（6例）、呕吐（2例）和腹胀（5例）的发生率高于余3组（P〈0．05）；4组产妇术后48h的血清MBP浓度、SEP及神经功能与术前相比均左异无显著性（P〉0．05）。结论小剂量低浓度的阿片类约物用于PCEA对血清MBP和SEP无影响。Objective To investigate the effeel of patient-controlled epidural analgesla（PCEA） with opioids on serous myelin basic protein（MBP） and somatosensory evoked potential （ SH）） of lower limbs in puerperants. Methods A total of 120 puerperants,after receiving cesarean section,were divided into four groups by random number table method as group B, Bit, MR and R randomly,and each group included 30 cases. After surgery, each case received PCEA：group B received 0. 008% batrophanol;group BR received 0. 008% butrophanol ＋ 0. 2% ropivacaine;group MR received 0. 004% morphine ＋ 0.2% rnpivacaine anti group R received 0.2% ropivacaine only. VAS score,OAA/S score, adverse effect occurrence,conc.entration changes of serous MBP,SEP of both lower limbs and neurological timction were observed at 2 h （ T1 ） ,4 h （ T2 ） , 8 h （ T3 ） , 12 h （ T4 ） , 24 h （ T5 ） and 48 h （T6） after surgery. Results VAS scores of group BR（ 1 . 64± 0. 38 ,1. 86 ± 0. 62 ,1. 93 ± 0. 67 ） andMR（1.74± 0.39,1.91 ±0.58, 1.98 ±0.63） at T3 ,T4 ,T5 were lower than those of group B（4.6±0.5,4.6 ±0.3,4.7 ±0. 3）and R（2.64 ±.0.41,2.83 ±0.91,3.37 ±0.87） （P〈0.05）. There was no significance in four groups in OAA/ S score at each point （P 〉 0.05 ）. Incidence of nausea （ 6 eases） , vomiting （ 2 cases） and abdominal distention （ 5 cases） of group M was higher than that of other three groups（P 〈 0.05）. There was no significant difference in concentrations of serous MBP,SEP anti neurological neurological in all tour groups between preoperative time and 48h after operation（P 〉 0.05）. Conclusion Lower-dnse and lowerconcentration opiuids used for PCEA have no influence on serum MBP and SEP.

关 键 词：阿片类药物 硬膜外术后自控镇痛 髓鞘碱性蛋白 体感诱发电位 

分 类 号：R614[医药卫生—麻醉学]