布托啡诺混合不同剂量氢吗啡酮用于二次剖宫产术后PCIA的改良效果  

Efficacy of butorphanol mixed with different doses of hydromorphone in improving PCIA after secondary cesarean section

作　　者：颜齐齐 徐世琴[1] Yan Qiqi;Xu Shiqin(Department of Anesthesiology,The 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,南京210004

出　　处：《中华麻醉学杂志》2022年第7期836-840,共5页Chinese Journal of Anesthesiology

摘　　要：目的评价布托啡诺混合不同剂量氢吗啡酮用于二次剖宫产术后PCIA的改良效果。方法择期在腰硬联合麻醉下行二次剖宫产术的单胎孕妇200例,年龄18~45岁,孕周37~42周,BMI≤30 kg/m^(2),ASA分级Ⅱ级,采用随机数字表法分为4组(n=50):布托啡诺(B组)和布托啡诺混合不同剂量氢吗啡酮组(BH_(1)组、BH_(2)组、BH_(3)组)。术中胎儿娩出后,静脉注射氟比洛芬酯50 mg、布托啡诺1 mg及格拉司琼3 mg。术毕连接并开启镇痛泵行PCIA,药物配置:B组布托啡诺0.24 mg/kg+格拉司琼6 mg,BH_(1)组布托啡诺0.24 mg/kg+氢吗啡酮0.06 mg/kg+格拉司琼6 mg,BH_(2)组布托啡诺0.24 mg/kg+氢吗啡酮0.09 mg/kg+格拉司琼6 mg,BH_(3)组布托啡诺0.24 mg/kg+氢吗啡酮0.12 mg/kg+格拉司琼6 mg,4组均用生理盐水稀释至150 ml,背景输注速率2.5 ml/h,PCA剂量3.0 ml,锁定时间15 min。采用VAS评分评价疼痛程度,当静息状态产妇按压镇痛泵后VAS评分仍>5分时,静脉注射氟比洛芬酯50 mg进行补救镇痛。分别于术后3、6、24和48 h时记录活动状态、静息状态和宫缩状态的VAS评分和警觉/镇静评分法(OAA/S)评分。记录术后48 h内镇痛补救情况、镇痛泵有效按压次数、总体满意度评分、OAA/S评分<5分和不良反应的发生情况及术后首次排气时间。结果与B组相比,BH_(1)组、BH_(2)组和BH_(3)组术后不同状态VAS评分降低,术后48 h内镇痛泵有效按压次数减少,总体满意度评分升高(P<0.05)。与BH_(1)组相比,BH_(2)组术后不同状态VAS评分差异无统计学意义(P>0.05),BH_(3)组术后静息状态VAS评分降低(P<0.05);与BH_(2)组相比,BH_(3)组术后不同状态VAS评分差异无统计学意义(P>0.05)。BH_(1)组、BH_(2)组和BH_(3)组术后48 h内镇痛泵有效按压次数和总体满意度评分差异无统计学意义(P>0.05)。4组术后首次排气时间、术后48 h内补救镇痛率、OAA/S评分<5分和不良反应的发生率比较差异无统计学意义(P>0.05)。结论相对于�Objective To evalaute the efficacy of butorphanol mixed with different doses of hydromorphone in improving patient-controlled intravenous analgesia(PCIA)after secondary cesarean section.Methods Two hundred American Society of Anesthesiologists physical statusⅡsingleton pregnant parturients,aged 18-45 yr,at 37-42 week gestation,with body mass index≤30 kg/m^(2),undergoing elective secondary cesarean section under combined spinal-epidural anesthesia,were allocated to one of 4 groups(n=50 each)using a random number table method:butorphanol(group B)and butorphanol mixed with different doses of hydromorphone groups(group BH_(1),group BH2 and group BH_(3)).Flurbiprofen 50 mg,butorphanol 1 mg and granisetron 3 mg were intravenously injected after delivery during operation.The analgesic pump was connected and turned on at the end of operation.The PCIA solution contained butorphanol 0.24 mg/kg and granisetron 6 mg in group B,butorphanol 0.24 mg/kg and hydromorphone 0.06 mg/kg and granisetron 6 mg in group BH_(1),butorphanol 0.24 mg/kg and hydromorphone 0.09 mg/kg and granisetron 6 mg in group BH2,butorphanol 0.24 mg/kg and hydromorphone 0.12 mg/kg and granisetron 6 mg in group BH_(3).The PCIA solution was diluted with normal saline to 150 ml,and the patient-controlled analgesia(PCA)pump was set up to deliver a 3.0 ml bolus dose with a 15-min lockout interval and background infusion at 2.5 ml/h in all the four groups.The degree of pain was evaluated using the VAS score.When the VAS score>5 points after pressuring analgesia pump at rest,flurbiprofen axetil 50 mg was intravenously injected for rescue analgesia.VAS scores during movement,at rest and during uterine contraction and observer′s assessment of alertness/sedation scale score were recorded at 3,6,24 and 48 h after operation.The requirement for rescue analgesia,effective pressing times of PCA,overall satisfaction score,OAA/S score<5,adverse reactions and time to the first flatus were recorded within 48 h after operation.Results Compared with group B,VAS scores in

关 键 词：布托啡诺 氢吗啡酮 剖宫产 再 镇痛 病人控制 疼痛 手术后 

分 类 号：R614[医药卫生—麻醉学]