盐酸丁丙诺啡用于剖宫产术后静脉镇痛的临床观察

Analgesic effect of bupremorphine for patients after caesarean section

目的观察盐酸丁丙诺啡用于剖宫产术后病人自控静脉镇痛(PC IA)的效果及对受此产妇乳汁喂养的新生儿的影响。方法选择自愿要求该方法术后镇痛的A SAⅠ、Ⅱ级产科病人20例,选用0.0015%丁丙诺啡+0.004%枢丹镇痛药,用一次性止痛注液泵给药,PC IA模式为负荷剂量+持续剂量2m l/h+单次剂量0.5 m l/h,术毕病人清醒,离开手术室前将止痛泵接于周围静脉并静注芬太尼50μg作为负荷剂量,随即开启PCA泵。由专人配药,专人观察。与随机抽取的20例采用硬膜外镇痛的产妇进行效果比较。结果所有采用该方法镇痛的产妇均达到满意效果,正常母乳喂养的新生儿未发生1例呼吸抑制等不良反应。结论丁丙诺啡具有镇痛效果确切、不良反应轻、对新生儿无不良影响等优点,可安全有效地应用于剖宫产术后病人的自控静脉镇痛。

Objective To observe the effects of bupremorphine for patient-controlled intravenous analgesia after caesarean section and the effects on neonates feeded by maternities. Methods Forty ASA Ⅰ -Ⅱ parturients scheduled for caesarean section were randomly divided into two groups： patient -controlled intravenous analgesia （PCIA） group and patlent-controlled epidural analgesia （PCIA） group. Patients in PCIA group were attached to a PCIA pump after receiving a loading dose of 50μg fentanyl. And the pump was started with 0. 0015% bupremorphine and 0. 004% ondansetron. The patients received 2 ml per hour and incremental dose of 0. 5ml per hour. PCEA group received epidural analgesia. Pain score （VSA 0-10）, sedation score （0-6） and the incidence of nausea and vomiting were recorded. Results There was no significant differences in pain and sedation scores and the incidence of vomiting between the two groups （P〉 0. 05）. Conclusion Bupremorphine for PCIA offers a satisfactory analgesia for labor operation patients. Meanwhile ,there are no adverse effects of suppressive respiration on neonates.