腰硬联合麻醉分娩镇痛复合静脉和硬膜外布托啡诺安全性及有效性研究  

A comparative study on the safety and effectiveness of intravenous and epidural administration of butorphanol during combined spinal-epidural anesthesia for labor analgesia

作　　者：韩学昌[1] 张亚杰[1] 张露[2] 乔传勋 葛军甫 邢群智[1] 蔡玮 田聪 马竹青 Han Xuechang;Zhang Yajie;Zhang Lu;Qiao Chuanxun;Ge Junfu;Xing Qunzhi;Cai Wei;Tian Cong;Ma Zhuqing(Department of Anesthesiology,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;Department of Surgery,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China;Department of Gynecology and Obstetrics,the First Affiliated Hospital,and College of Clinical Medicine of Henan University of Science and Technology,Luoyang 471003,China)

机构地区：[1]河南科技大学临床医学院,河南科技大学第一附属医院麻醉科,洛阳471003 [2]河南科技大学临床医学院,河南科技大学第一附属医院手术部,洛阳471003 [3]河南科技大学临床医学院,河南科技大学第一附属医院妇产科,洛阳471003

出　　处：《国际麻醉学与复苏杂志》2024年第6期571-578,共8页International Journal of Anesthesiology and Resuscitation

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210603)。

摘　　要：目的探讨静脉和硬膜外复合给予布托啡诺在腰硬联合麻醉分娩镇痛效果中的有效性和安全性。方法选择要求行分娩镇痛的足月自然分娩初产妇297例,按随机数字表法分为3组:无布托啡诺组(Ⅰ组,98例)、布托啡诺硬膜外给药组(Ⅱ组,100例)、布托啡诺静脉+硬膜外联合给药组(Ⅲ组,99例)。3组产妇均行腰硬联合麻醉分娩镇痛:蛛网膜下腔给予舒芬太尼2μg,硬膜外腔分别给予不同混合液3 ml(试验量)+10 ml(Ⅰ组为罗哌卡因150 mg+舒芬太尼48μg,Ⅱ组、Ⅲ组为罗哌卡因150 mg+舒芬太尼48μg+布托啡诺2 mg,均使用生理盐水稀释到200 ml);接着Ⅰ组、Ⅱ组给予生理盐水5 ml,Ⅲ组给予布托啡诺0.5 mg/5 ml入墨菲式滴管静脉滴注;在硬膜外腔以7 ml/h泵入混合液直至胎盘娩出后12 h。宫口开至3 cm分娩镇痛前即刻(T_(0))、给予硬膜外总量后20 min即刻(T_(1))、宫口开全即刻(T_(2))、胎儿娩出即刻(T_(3))、胎盘娩出即刻(T_(4))、胎盘娩出后4 h(T_(5))、胎盘娩出后8 h(T_(6))分别采用视觉模拟评分法(VAS)疼痛评分、Ramsay镇静评分和Bromage改良评分对产妇进行疼痛、镇静和下肢运动神经阻滞程度评分,同时记录产妇T_(1)、T_(2)时的平均动脉压(MAP)、心率、脉搏血氧饱和度(SpO_(2))、呼吸频率;检测T_(0)、T_(4)、T_(6)时产妇静脉血P物质、5-羟色胺(5-HT)、亮脑啡肽、β-内啡肽(β-EP)含量;记录第一、第二、第三产程时间及使用催产素例数,新生儿1 min、5 min、10 min Apgar评分和脐动脉血气分析[pH、动脉血二氧化碳分压(PaCO_(2))、动脉血氧分压(PaO_(2))、乳酸(Lac)];观察记录产妇不良反应(分娩方式改变、呼吸抑制、嗜睡、低血压、恶心、呕吐、寒战、尿潴留、皮肤瘙痒)发生情况。结果T_(2)、T_(3)时,Ⅱ组和Ⅲ组VAS疼痛评分低于Ⅰ组,且Ⅲ组低于Ⅱ组(均P<0.05);T_(1)、T_(2)时,Ⅱ组、Ⅲ组Ramsay镇静评分高于Ⅰ组,且Ⅲ组高于Ⅱ组(均P<0.05);与TObjective To explore the clinical effect and safety of intravenous and epidural administration of butorphanol in the analgesic effect of combined spinal-epidural anesthesia for labor anesthesia.Methods A total of 297 primiparous women in full-term spontaneous delivery who requested labor analgesia were selected.According to the random number table method,they were divided into three groups:a non-butorphanol group(groupⅠ,n=98),a butorphanol epidural administration group(group Ⅱ,n=100),and a butorphanol combined intravenous and epidural administration group(group Ⅲ,n=99).All three groups of parturients underwent combined spinal-epidural anesthesia for labor analgesia:2μg of sufentanil was administered in the subarachnoid,and 3 ml(the test volume)+10 ml of different mixed solutions were given in the epidural space(group Ⅰ:ropivacaine 150 mg+sufentanil 48μg;group Ⅱ and group Ⅲ:ropivacaine 150 mg+sufentanil 48μg+butorphanol 2 mg;and all the above solutions were diluted to 200 ml with normal saline).Next,5 ml of normal saline were given to group Ⅰ and group Ⅱ,while group Ⅲ was intravenously given 0.5 mg/5 ml of butorphanol via a Murphy style dropper.The mixture was pumped into the epidural space at 7 ml/h until 12 h after delivery of the placenta.The Visual Analogue Scale(VAS)score,Ramsay Sedation score and Bromage Modified score were used to evaluate the degree of pain,sedation and motor nerve block in the lower limbs,immediately before the opening of the uterus to 3 cm for labor analgesia(T_(0)),20 min immediately after the administration of total epidural volume(T_(1)),immediately after the opening of the uterus(T_(2)),immediately after the delivery of the fetus(T_(3)),immediately after the delivery of the placenta(T_(4)),4 h after the delivery of the placenta(T_(5)),and 8 h after the delivery of the placenta(T_(6)).Meanwhile,the mean arterial pressure(MAP),heart rate,pulse oxygen saturation(SpO_(2))and respiratory rate were recorded.The levels of substance P,5-hydroxytryptamine(5-HT),leu-enkeph

关 键 词：静脉麻醉 硬膜外麻醉 腰硬联合麻醉 分娩镇痛 

分 类 号：R614[医药卫生—麻醉学] R714.3[医药卫生—外科学]