布托啡诺在剖宫产术后硬膜外镇痛中最佳剂量的探讨

目的探讨布托啡诺用于剖宫产术后硬膜外镇痛的最佳剂量。方法 60例剖宫产产妇,ASAⅠ-Ⅱ级,随机分为三组,每组20例。分别予0.135%布比卡因＋0.002%布托啡诺（Ⅰ组）、0.135%布比卡因＋0.004%布托啡诺（Ⅱ组）及0.135%布比卡因＋0.006%布托啡诺（Ⅲ组）行硬膜外镇痛。采用负荷量＋持续剂量给药模式,持续剂量背景流速2 ml/h。结果术后8 hⅡ、Ⅲ组VAS均低于Ⅰ组（P〈0.01）,BCS高于Ⅰ组（P〈0.05）,而Ⅱ组的Romesay评分高于Ⅰ、Ⅲ组（P〈0.05）。术后Ⅰ、Ⅱ组各出现呕吐1例（5.0%）,而Ⅲ组发生7例（35.0%）,差异有显著性（P〈0.01）。结论布托啡诺剖宫产术后硬膜外镇痛效果确切,恶心呕吐及瘙痒的发生率低;0.135%布比卡因＋0.004%布托啡诺是较为安全的有效剂量。

Effect Exploration on Different Dosage of Butorphanol in Epidural Analgesia after Caesarean Section

Objective To study the optimal dose of butorphanol in epidural analgesia after caesarean section.Methods Sixty parturients with ASA Ⅰto Ⅱ underwent caesarean section,were randomized into three groups,with 20 cases for each.In the postoperative epidural analgesia,0.135% bupivacaine and 0.002% butorphanol was administrated to group Ⅰ,0.135% bupivacaine and 0.004% butorphanol to group Ⅱ,and 0.135% bupivacaine and 0.006% butorphanol to group Ⅲ.All the drugs were given with a loading-continuous model,and the continuous background infusion was 2 ml/h.Results Among three groups comparison,the VAS of both group Ⅱ and Ⅲ were obviously lower than that of group Ⅰ（P〈0.01）,the BCS of both Ⅱ and Ⅲ were significantly higher than that of group Ⅰ（P0.05）,and the Romesay score of group Ⅱ was higher than group Ⅰ and Ⅲ（P0.05）.The incidence of nausea and vomiting was 5% in both group Ⅰand Ⅱ,both were less than 35% of group Ⅲ（P〈0.01）.Conclusion Butorphanol can provide effective analgesia in epidural analgesia after caesarean section with fewer side effects,especially when the dosage of 0.135% bupivacaine and 0.004% butorphanol was used.