布托啡诺与曲马多用于剖宫产术镇痛效果的比较研究

目的:探讨布托啡诺静脉自控镇痛(PCIA)与曲马多PCIA用于剖产术后的镇痛效果及不良反应。方法:纳入2017年10月至2018年1月腰硬联合麻醉下择期剖宫产术的孕妇100例,随机分为布托啡诺组(B)组和曲马多组(Q)组,每组50例。娩出胎儿后B组给予布托啡诺PCIA(背景量0.16 mg/h,追加0.16 mg,锁定时间20分钟),Q组给予曲马多PCIA(背景量1.6 mg/h,追加1.6 mg,锁定时间20分钟)。记录两组产妇连接镇痛泵后4小时、8小时、24小时、48小时视觉模拟评分、镇静评分、患者自控镇痛(PCA)按压总次数和有效按压比,术后48小时镇痛药物使用量、生命体征、不良反应、哺乳及新生儿情况,48小时患者的焦虑抑郁评分以及患者满意度。结果:与Q组相比,B组各个时间点静息痛及运动痛的视觉模拟评分都明显降低(P<0.05),仅6%的患者需要术后补充镇痛药物。B组PCIA后4小时恶心、呕吐、头晕及24小时嗜睡的发生率较Q组明显降低(P<0.05),48小时内总哺乳次数多(P<0.05),且48小时内焦虑抑郁评分较低(P<0.05),患者的满意度明显提高(P=0.00)。结论:与曲马多PCIA相比,布托啡诺PCIA可以为剖宫产产妇提供更完善的术后镇痛,术后4小时不良反应少,患者满意度高,提高了母乳喂养的次数。

Comparison of Analgesic Effect between Butorphanol and Tramadol in Cesarean Section

Objective:To explore the analgesic effect and adverse reaction of pure butorphanol patient controlled intravenous analgesia(PCIA) and pure tramadol PCIA in cesarean section.Methods:100 pregnant women with selected cesarean section under combined spinal epidural anesthesia from October 2017 to January 2018 were selected.They were randomly assigned into group B and group Q.50 patients in group B used butorphanol PCIA(background dose 0.16 mg/h,bolus 0.16 mg,lockout time 20 min),50 patients in group Q used tramadol PCIA(background dose 1.6 mg/h,bolus 1.6 mg,lockout time 20 min).Pump system was connected after the delivery of baby and record the analgesic effect by visual analogue scale,Ramsay scores at 4 h,8 h,24 h,48 h postoperative,the total times of PCA pressing,the ratio of effective PCA pressing and the usage of additional analgesia agents in 48 h;Vital signs,adverse effect,lactation and the neonatal condition,the anxiety and depression score at48 hours and the satisfaction of patients are also observed.Results:Comparing with group Q,the rest pain and motion pain at each time points in group B were significantly lower(P<0.05),just 6% need additional analgesia agents.The ratio of nausea,vomiting and dizziness in 4 hours and drowsiness in 24 hours were significantly decreased(P<0.05).The total lactation frequency in 48 hours was much more(P<0.05),the anxiety and depression score in 48 hours was lower(P<0.05),and the satisfaction of all patients was more higher(P=0.00).The milking time and the time of lactation had no statistical difference.Conclusions:Comparing with pure tramadol PCIA,the pure butorphanol PCIA could provide much better analgesic effect for pregnant women after cesarean section,it has less adverse effect and high degree of satisfaction of patients.Improve the times and quality of breast feeding.