不同剂量布托啡诺用于剖宫产术后自控镇痛效果的比较  

Postoperative patient-controlled analgesia with butorphanol in puerperants underwent cesarean section

作　　者：毛毛[1] 李彩娟[1] 沈晓凤[1] 徐世琴[1] Mao Mao;Li Caijuan;Shen Xiaofeng;Xu Shiqin(Department of A nesthesialogy, Affiliated Obstetrics and Gynecology Hospital of Nanjing Medical University, Nanjing Maternity and Child Health Care Hospital, Nanjing 210004, China)

机构地区：[1]南京医科大学附属妇产医院(南京市妇幼保健院)麻醉科,210004

出　　处：《国际麻醉学与复苏杂志》2018年第4期294-298,共5页International Journal of Anesthesiology and Resuscitation

摘　　要：目的比较不同剂量布托啡诺用于剖宫产术后自控镇痛的效果。方法择期行剖宫产术的初产妇300例，ASA分级Ⅰ、Ⅱ级，采用随机数字表法分为6组（每组50例）：曲马多200．0μg·kg^-1·h^-1组（T组）、布托啡诺3.0μg·kg^-1·h^-1组（B1组）、布托啡诺3．5μg·kg^-1·h^-1组（B2组）、布托啡诺4．0μg·kg^-1·h^-1组（B3组）、布托啡诺4．5μg·kg^-1·h^-1组（B4组）、布托啡诺5．0μg·kg^-1·h^-1组（B5组）。于胎儿娩出后，T组静脉注射负荷量曲马多50mg，B1组～B5组静脉注射布托啡诺0．5mg，术毕接患者自控静脉镇痛（patient-controlled intravenous analgesia，PCIA）泵。观察麻醉前（T0）、开启镇痛泵时（T1）及开启镇痛泵后30min（T2）、2h（T3）、4h（T4）、24h（T5）、48h（T6）时产妇切口静息痛、运动痛和宫缩痛的VAS评分，改良警觉／镇静（observer’s assessment of alertnesstion／sedation，OAA/S）评分，T5、T6时患者自控镇痛（patient controlled analgesia，PCA）实际及有效按压次数，排气时间，泌乳开始和发动时间，接泵后48h内副作用发生率及产妇满意度。结果与T组比较，B1组T5时切口静息痛、运动痛和宫缩痛VAS评分升高（P〈0．05），B2组～B5组与T组比较，差异无统计学意义（P〉0．05）；各组T6时切口静息痛、运动痛和宫缩痛VAS评分差异均无统计学意义（P〉0．05）；各组OAA／S评分差异无统计学意义（P〉0．05）；与T组比较，B1组B、R时PCA实际及有效按压次数增多（P〈0．05）。各组间比较，排气时间、泌乳开始和发动时间差异无统计学意义（P〉0．05）；B2组、B3组较其他组产妇满意度高（P〈0．05）。T组与B4组、B5组导致头晕、嗜睡、恶心及幻觉等副作用的发生率有增高趋势，但差异无统计学意义（P〉0．05）。结论布托啡诺用于剖宫产术后PCIA时，采用3．5μg·kg^-1·h^-1或4．0μg·kg^-1·h^-1的泵注Objective To compare the effect of postoperative patient-controlled intravenous analgesia （PCIA） with doses of butorphanol on puerperant after cesarean section. Methods Three hundred ASA Ⅰ or Ⅱ patients underwent cesarean section were randomly divided into 6 groups （n=50） respectively received tramadol 200.0 μg·kg^-1·h^-1 （group T）, butorphanol 3.0 μg·kg^-1·h^-1（group B1）, butorphanol 3.5 μg·kg^-1·h^-1（group B2）, butorphanol 4.0μg·kg^-1·h^-1（group B3）, butorphanol 4.5μg·kg^-1·h^-1（group B4）, or butorphanol 5.0 μg·kg^-1·h^-1（group B5）. The loading doses were 50 mg for tramadol in group T, and 0.5 mg for butorphanol in group B1-B5, and PCIA was initiated after operation. VAS and observer＇s assessment of alertness/sedation （OAA/S） scale were employed to assess the severity of rest pain, motion pain, and uterus systole pain before anesthesia（T0）, 0（T1）, 30 min（T2）, 2 h（T3）, 4 h（T4）, 24 h（T5） and 48 h（T6） after the initiation of PCIA. The time to flatus, time to breasffeeding, time to lactation, side effects, and satisfaction scores were recorded. Results Compared with group T, VAS scores of rest pain, motion pain, and uterus systole pain at T5 in group B 1 were higher （P〈0.05）, while no significant changes occurred in group B2-B5 （P〉0.05）. No differences were found in pain scores at T6 among 6 groups （P〉0.05）. Compared with group T, patients in group B1 need more PCIA bolus during T5-T6 （P〈0.05）. Patients in group B2 and B3 showed the highest satisfaction scores among all groups （P〈0.05）. No significant differences among 6 groups were found in time to flatus, time to breasffeeding, and time to lactation, and OAA/S scores at different time points （P〉0.05）. Conclusions PCIA with butorphanol at a dose of 3.5 μg·kg^-1·h^-1 or 4.0 μg·kg^-1·h^-1 may provide optimal postoperative analgesia after cesarean section.

关 键 词：布托啡诺 剖宫产 患者自控静脉镇痛 

分 类 号：R614[医药卫生—麻醉学]