丁丙诺啡用于子痫前期患者剖宫产术后硬膜外镇痛的效果评价

Efficacy of Buprenorphine for Postoperative Epidural Analgesia in Patients with Severe Preeclampsia

目的观察丁丙诺啡用于子痫前期患者剖宫产术后硬膜外镇痛的效果及副作用。方法将44例子痫前期在硬膜外麻醉下行剖宫产患者随机分为丁丙诺啡组(组Ⅰ)及吗啡组(组Ⅱ),均于胎儿娩出后硬膜外给予术后镇痛负荷量,并在关腹时接上镇痛泵。组I负荷量为丁丙诺啡0.15 mg,组Ⅱ为吗啡0.5 mg,均用生理盐水稀释成6 ml;泵内配方组Ⅰ为丁丙诺啡0.45 mg+氟哌利多5 mg+布比卡因100 mg,组Ⅱ为吗啡2 mg+氟哌利多5 mg+布比卡因100 mg,均用生理盐水稀释成100 ml。两组镇痛泵固定给药速度2.1 ml/h,持续输注48 h。记录输注后1、4、8、12、24、364、8 h患者的平均动脉压、心率、脉搏、氧饱和度、疼痛评分、镇静评分;记录输注后48 h内硫酸镁用量、辅助镇痛药的使用以及阴道出血量,并观察产妇恶心、呕吐、皮肤骚痒、尿潴留、呼吸抑制等不良反应。结果组Ⅰ疼痛评分除1、4和48 h与组Ⅱ相似,其余各时点均低于组Ⅱ;镇静程度评分均高于组Ⅱ;辅助药物使用低于组Ⅱ,两组不良反应相似,48 h阴道出血量亦无明显差异。结论丁丙诺啡的硬膜外镇痛、镇静效果优于吗啡,适用于子痫前期患者剖宫产术后镇痛。

Objective To observe the efficacy of buprenorphine used for postoperative epidural analgesia in patients with severe preeclampsia. Methods Forty-four patients receiving epidural analgesia after cesarean section were randomly divided into two groups. After labor, loading dose was given： huprenorphine （0. 15 mg. group Ⅰ ） and morphine （0.5 mg, group Ⅱ ） were diluted for 6 ml with 0.9 % NaCI. The pumps were connected 15 rain before ending the operation： huprenorphine 0.45 mg＋droperidol 5 mg＋hupivacaine 100 mg （group Ⅰ ） and morphine 2.0 mg＋droperidol 5 mg＋bupivacaine 100 mg （group Ⅱ ） were diluted for 100 ml with 0.9 % NaCl. The fixed rate of infusion was 2. 1 ml/h. Mean arterial pressure （MAP）, heart rate （HR）, saturation （SpO2）, visual analogue score （VAS）, sedation score （SS） were recorded at 1, 4, 8, 12, 24, 36 and 48 h after operation. The consumption of MgSO, and use of adjuvant analgesic were recorded for 48 h. The complications and the vaginal blood loss were recorded for 2 days. Results The changes of vital signs had no significant difference between the two groups. VAS in the group Ⅰwas slightly lower than in the group Ⅱat each time point except for 1.4 and 48 h. The complications and vaginal blood loss had no significant difference. Conclusion Buprenorphine is suitable for epidural analgesia in severe preeclampsia after cesarean section. The effects of analgesia and scdation were superior to those of morphine.