全身麻醉剖宫产术后超声引导下腰方肌外侧路阻滞对布托啡诺患者自控静脉镇痛ED_(50)的影响  

Effects of ultrasound-guided lateral quadratus lumborum block on ED_(50)of butorphanol by patient controlled intravenous analgesia after cesarean section under general anesthesia

作　　者：纪宏新[1] 何世琼[2] 蔡云亮[1] 王嘉炜 张茜 秦棠琦 JI Hong-xin;HE Shi-qiong;CAI Yun-liang;WANG Jia-wei;ZHANG Qian;QIN Tang-qi(Department of Anesthesiology,Longgang District People's Hospital of Shenzhen/the Second Affiliated Hospital,Chinese University of Hong Kong,Shenzhen GUANGDONG 518172,China;Department of Gynaecology,Longgang District People's Hospital of Shenzhen/the Second Affiliated Hospital,Chinese University of Hong Kong,Shenzhen GUANGDONG 518172,China)

机构地区：[1]深圳市龙岗区人民医院/香港中文大学(深圳)附属第二医院麻醉科,广东深圳518172 [2]深圳市龙岗区人民医院/香港中文大学(深圳)附属第二医院妇产科,广东深圳518172

出　　处：《中国新药与临床杂志》2024年第11期837-841,共5页Chinese Journal of New Drugs and Clinical Remedies

基　　金：深圳市龙岗区科技创新项目(LGWJ2022-25)。

摘　　要：目的探讨全身麻醉(全麻)剖宫产术后超声引导下腰方肌外侧路阻滞(QLB-1)对布托啡诺患者自控静脉镇痛(PCIA)的半数有效剂量(ED_(50))的影响。方法选择妊娠37~42周拟行全麻剖宫产产妇,ASA分级Ⅱ级,随机分为Q组(QLB-1复合布托啡诺术后镇痛组)和C组(单纯布托啡诺术后镇痛组),预计每组35例。2组均选择气管插管全麻,Q组术毕拔管前,在超声引导下行双侧QLB-1,每侧给予0.3%罗哌卡因25 mL;C组不行神经阻滞。2组均在拔管后行PCIA,以术后48 h内静息状态视觉模拟量表(VAS)评分≤3分或运动状态VAS评分≤4分为镇痛效果满意标准。PCIA中布托啡诺起始剂量为4μg·kg^(-1)·h^(-1),按改良序贯法调整,剂量梯度为0.25μg·kg^(-1)·h^(-1)。采用Probit概率回归法计算布托啡诺的ED_(50)及其95%置信区间(95%CI)。结果C组和Q组纳入样本量分别为28例和31例。C组布托啡诺的ED50为3.81μg·kg^(-1)·h^(-1)(95%CI:2.87~4.25μg·kg^(-1)·h^(-1)),Q组为2.45μg·kg^(-1)·h^(-1)(95%CI:2.16~2.70μg·kg^(-1)·h^(-1))。2组镇痛满意的产妇中,C组嗜睡、头晕和恶心的发生率显著高于Q组(P<0.05)。结论全麻剖宫产术后行超声引导下QLB-1联合布托啡诺PCIA镇痛可使布托啡诺的ED_(50)降低36%,且减少不良反应的发生。AIM To investigate the effect of ultrasound-guided lateral quadratus lumborum block(QLB-1)on the median effective dosage(ED_(50))of butorphanol by patient controlled intravenous analgesia(PCIA)performed after cesarean section under general anesthesia.METHODS Parturients were scheduled for cesarean section under general anesthesia,gestation 37-42 weeks,ASA physical statusⅡwere assigned into two groups,group Q(QLB-1 combined with butorphanol PCIA)and group C(butorphanol PCIA).Each group was expected to have 35 cases.Both groups were administered general anesthesia with endotracheal intubation.The group Q:0.3%ropivacaine with 25 mL were injected in the QLB-1 in each side respectively under ultrasound guidance before extubation at the end of the surgery.The group C:no nerve block.The two groups underwent PCIA after extubation.The scores of resting visual analogue scale(VAS)≤3 points or VAS of motion state≤4 points within 48 hours after operation were used as the criteria of analgesia satisfaction.The initial dose of butorphanol with PCIA was 4μg·kg^(-1)·h^(-1),adjusted by the modified Dixon's up-and-down method with a dose gradient of 0.25μg·kg^(-1)·h^(-1).Probit analysis was used for calculating ED_(50)and 95%confidence interval(CI)of butorphanol PCIA for satisfactory analgesia.RESULTS The sample size included in group Q and group C were 31 and 28 cases,respectively.The ED_(50)of butorphanol PCIA for satisfactory analgesia was 3.81μg·kg^(-1)·h^(-1)for the group C(95%CI:2.87 to 4.25μg·kg^(-1)·h^(-1))and 2.45μg·kg^(-1)·h^(-1)for the group Q(95%CI:2.16 to 2.70μg·kg^(-1)·h^(-1)).In the parturients with satisfactory analgesia of the two groups,the incidence of drowsiness,dizziness and nausea was higher in the group C than that in the group Q(P<0.05).CONCLUSION The ED_(50)of butorphanol PCIA combined with QLB-1 for satisfactory relieve postoperative analgesia after cesarean section under general anesthesia reduce butorphanol PCIA alone by 36% and reduce the incidence of adverse reactions.

关 键 词：剖宫产术 麻醉 全身 神经传导阻滞 患者自控静脉镇痛 布托啡诺 半数有效剂量 

分 类 号：R971[医药卫生—药品]