不同剂量布托啡诺应用于剖宫产术后硬膜外镇痛的临床研究

【目的】将不同剂量布托啡诺应用于剖宫产术后硬膜外镇痛，观察其镇痛效果，探讨布托啡诺用于剖宫产术后硬膜外镇痛的最佳剂量和配伍。【方法】180例（ASAⅠ～Ⅱ）剖宫产患者随机分为六组，每组30例，对照组（C组），实验组（E2、E3、E4、E5、E6组）。镇痛液为：C组，0．125％罗哌卡因＋0．005％吗啡；E2组，0．125％罗哌卡因＋0．004％布托啡诺；E3组，0．125％罗哌卡因＋0．005％布托啡诺；E4组，0．125％罗哌卡因＋0．006％布托啡诺；E5组，0．125％罗哌卡因＋0．007％布托啡诺；E6组，0．125％罗哌卡因＋0．008％布托啡诺。采用负荷剂量＋持续剂量给药模式，持续剂量背景流速2mL／h。【结果】①E2组VAs评分分别在4h、8h、12h点高于C组，E3、E4、E5、E6组与C组无明显差异；E2组BCS评分在4h、8h、12h点低于C组，E3、E4、E5、E6组与C组无明显差异。②并发症：C组恶心呕吐、皮肤瘙痒发生率高于E2、E3、E4、E5、E6组，且差异显著。【结论】布托啡诺应用于剖宫产术后硬膜外镇痛效果确切、副作用发生率低，可以0．005％布托啡诺＋0．125％罗哌卡因作为初始剂量，再根据病人的镇痛效果情况酌情增加布托菲诺的剂量。

Clinical Study on Postoperative Epidural Analgesia after Caesarean Section with Different Doses of Butorphanol

[Objective] To observe the analgesic effects with different doses of butorphanol for postoperative epidural analgesia after caesarean section, and to find the optimal dose of butorphanol on postoperative epidural analgesia after caesarean section. [Methods] A total of 180 ASA I - II patients undergoing caesarean section were randomly divided into six groups. The control group （Group C, n =30） received the mixture of 0. 125% ropivacaine and 0. 005% morphine. Group E2 （ n =30） received the mixture of 0. 125% ropivacaine and 0. 004% butorphanot. Group E3 （ n =30） received the mixture of 0. 125% ropivacaine and 0. 005% butorphanol. Group E4 （ n =30） received the mixture of 0. 125% ropivacaine and 0. 006% butorphanol. Group E5 （ n = 30） received the mixture of 0. 125% ropivacaine and 0. 007 % butorphanol. Group E6 （ n = 30） received the mixture of 0. 125% ropivacaine and 0. 0080/00 butorphanol. The six groups were carried out by loading-continuous administration with continuous doses of 2 mL/h by a pump. [Results] VAS in group E2 was higher than that in Group C at 4h, 8h and 12h during postoperative, while it showed no difference between group E3, E4 , E5, E6 and Group C. BCS in Group E2 was lower than that in Group C at 4h, 8h and 12h after operation, while it showed no difference between Group E3, E4, E5, E6 and Group C. The incidence of complications such as nausea, vomiting and itch of skin in Group C was higher than that in Group E2, E3 , E4 , E5, E6 , and the difference was significant. [Conclusion] Butorphanol has satisfied analgesia effect during PCEA after caesarean section and the rate of its side effects was lower than that of morphine. It was suitable with the mixture of 0. 125% ropivacaine and 0. 006% butorphanol .