布托啡诺在剖宫产患者术后镇痛的效果评估  

Effect of butorphanol on postoperative analgesia in cesarean section

作　　者：张莹[1] 张光磊 冯玲 龚洵 Zhang Ying;Zhang Guanglei;Feng Ling;Gong Xun(Department of Obstetrics and Gynecology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China;Department of Anesthesiology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院妇产科,武汉430030 [2]华中科技大学同济医学院附属同济医院麻醉科,武汉430030

出　　处：《中国医师进修杂志》2023年第7期610-614,共5页Chinese Journal of Postgraduates of Medicine

摘　　要：目的:评估剖宫产术停用患者自控静脉镇痛(PCIA)泵后布托啡诺的镇痛效果及不良反应。方法:回顾性选取2021年3月20日—12月8日华中科技大学同济医学院附属同济医院行择期剖宫产患者120例,术毕均给予PCIA泵,24 h停用后分为布托啡诺组、双氯芬酸钠栓组、对照组,每组各40例,布托啡诺组患者予以酒石酸布托啡诺1.0 mg+100 ml 0.9%氯化钠静脉滴注,双氯芬酸钠栓组患者予以双氯芬酸钠栓25 mg纳肛,对照组患者不再使用镇痛药物,比较三组患者生命体征、镇痛效果以及不良反应,同时比较三组患者术后膀胱及胃肠功能恢复及新生儿黄疸情况。结果:布托啡诺组停PCIA泵后3、4 h视觉模拟评分(VAS)明显低于对照组[(2.16±0.09)分比(2.72±0.25)分、(2.21±0.10)分比(2.72±0.21)分],差异有统计学意义(P<0.05),而停PCIA泵后6、12 h VAS比较差异无统计学意义(P>0.05)。双氯芬酸钠栓组停PCIA泵后3 h VAS明显低于对照组[(2.06±0.10)分比(2.16±0.09)分],差异有统计学意义(P<0.05),而4、6和12 h VAS比较差异无统计学意义(P>0.05)。布托啡诺组3 h VAS低于双氯芬酸钠栓组,但差异无统计学意义(P>0.05)。布托啡诺组术后4 h VAS低于双氯芬酸钠栓组[(2.21±0.10)分比(2.56±0.12)分],差异有统计学意义(P<0.05)。布托啡诺组术后首次下床时间及排尿时间较双氯芬酸钠组和对照组推迟[(28.32±1.36)h比(25.94±0.92)h和(24.50±0.64)h、(29.05±1.67)h比(26.76±1.05)h和(25.06±0.65)h],差异有统计学意义(P<0.05),而双氯芬酸钠栓组肛门排气时间推迟,但差异无统计学意义(P>0.05)。结论:剖宫产术停用PCIA泵后仍应使用镇痛药物缓解患者疼痛,此时布托啡诺镇痛效果优于双氯芬酸钠栓,但应加强护理,敦促患者早活动,以减少尿潴留的发生。Objective To evaluate the analgesic effect and adverse reactions of butorphanol after stopping patient controlled intravenous analgesia(PCIA)pump in cesarean section.Methods One hundred and twenty patients with cesarean section in Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology from March 20,2021 to December 8,2021 were divided into three groups as follows:butorphanol group,diclofenac sodium suppository group and control group and there were 40 patients in each group.The vital signs,analgesic effect and adverse reactions among the three groups were compared.Meantime,the bladder and gastrointestinal function recovery and neonatal jaundice in three groups were also compared.Results The visual analogue score(VAS)in butorphanol group was significantly lower than that of control group at 3 and 4 h after stopping PCIA pump:(2.16±0.09)scores vs.(2.72±0.25)scores,(2.21±0.10)scores vs.(2.72±0.21)scores,P<0.05,but there was no significant difference in VAS at 6 and 12 h after stopping PCIA pump.VAS in diclofenac sodium suppository group was significantly lower than that of control group at 3 h after stopping PCIA pump:(2.06±0.10)scores vs.(2.16±0.09)scores,P<0.05,but there was no significant difference in VAS at 4,6 and 12 h(P>0.05).The 3 h VAS of butorphanol group was lower than that of diclofenac sodium suppository group,but the difference was not statistically significant(P>0.05).The VAS of butorphanol group was lower than that of diclofenac sodium suppository group at 4 h after operation:(2.21±0.10)scores vs.(2.56±0.12)scores,and the difference was statistically significant(P<0.05).The first time of getting out of bed and urination time in butorphanol group were later than diclofenac sodium suppository group and control group:(28.32±1.36)h vs.(25.94±0.92)h and(24.50±0.64)h,(29.05±1.67)h vs.(26.76±1.05)h and(25.06±0.65)h,and the difference was statistically significant(P<0.05).While the anal exhaust time in diclofenac sodium suppository group was delayed,b

关 键 词：镇痛 剖宫产术 布托啡诺 双氯芬酸钠栓 

分 类 号：R719.8[医药卫生—妇产科学]