吗啡或复合布托啡诺在剖宫产术后硬膜外镇痛的临床观察

目的比较盐酸吗啡和盐酸吗啡复合酒石酸布托啡诺用于剖宫产手术后患者硬膜外自控镇痛的效果及不良反应,探讨剖宫产手术后硬膜外镇痛用药的较佳方案。方法选择80例ASAⅠ或Ⅱ级在腰硬联合麻醉下行剖宫产手术,术后行硬膜外镇痛,依据硬膜外镇痛用药不同随机分组,按双盲法随机分为观察组(MB组)和对照组(M组)。观察组镇痛药为酒石酸布托啡诺2 mg+盐酸吗啡4 mg+0.09%甲磺酸罗哌卡因+生理盐水至110 mL;对照组镇痛药为盐酸吗啡4 mg+0.09%甲磺酸罗哌卡因+生理盐水至110 mL,分别于术后6、12、24、48 h四个时间点,由专人观察并记录两组患者的血压、心率、脉搏氧饱和度、呼吸频率,进行镇痛、镇静评分,记录各组患者皮肤瘙痒、低血压、呼吸抑制、恶心呕吐等不良反应的例数。结果 MB组和M组在术后四个时间点镇痛、镇静评分无统计学意义,MB组皮肤瘙痒、恶心呕吐不良反应发生率明显下降,与M组有统计学意义。结论盐酸吗啡复合酒石酸布托啡诺用于剖宫产手术后患者硬膜外自控镇痛具有多模式镇痛的效果,在镇痛效果优良的同时,降低了皮肤瘙痒、恶心呕吐的发生率,使产科术后镇痛的质量提升,患者舒适度、满意度提高。

Clinical observation of Morphine or Morphine compounding Butorphanol for postoperative epidural analgesia in cesarean section

Objective To explore the preferred option of postoperative epidural analgesia medication for caesarean section by comparing the effects and adverse reactions of morphine hydroehloride or morphine hydrochloride compounding tartaric acid butorphanol. Methods All of 80 cases cesarean section for Ⅰ to Ⅱ of ASA were operated under the spinal epidural anesthesia, all cases were randomly divided into two groups by double blind method according to the epidural medication： the observation group （MB group） and the control group （M group）. Analgesic drugs of MB group were： 2 mg of tartrate bu- torphanol, 4 mg of morphine hydroehloride and 0.09% ropivacaine mesylate were added in normal saline to 110 mL; for the M group： 4 mg of morphine hydroehloride and 0.09% ropivacaine mesylate were added in normal saline to 110 mll. Two groups were observed at 6, 12, 24, 48 h after surgery and record blood pressure, heart rate, oxygen saturation, respiratory rate and carried out analgesia, sedation score. The number of cases of each group occurred with skin itching, hypotension, respiratory depression, nausea, vomiting and other adverse reactions were record. Results There was no significant differ- ence between MB group and M group in analgesia, sedation score in four postoperative periods. The adverse reaction rates of skin itching, nausea, vomiting in MB group decreased significantly. Conclusion There is a multi-modal analgesic effect in patients with postoperative epidural controlled analgesia using morphine hydrochloride compounding tartaric acid butor- phanol. At the same time, the adverse reaction rates of skin itching, nausea, vomiting were reduced significantly, which can improve the quality of obstetric postoperative analgesia and increase comfort and satisfaction of patients.