酒石酸布托啡诺预防剖宫产术后硬膜外吗啡镇痛皮肤瘙痒的临床观察

The clinic observation of butorphanol tartrate for prevention of itching in postoperative epidural analgesia with morphine after caesarean section

目的研究酒石酸布托啡诺对剖宫产产妇术后镇痛皮肤瘙痒的预防作用。方法选择在腰硬联合麻醉下行剖宫产产妇60例,ASA均为Ⅰ～Ⅱ级,均采用硬膜外镇痛,随机分为两组:布托啡诺组(B组),对照组(C组),每组各30例。胎儿取出后5min后硬膜外给予镇痛首剂。B组:镇痛首剂采用布托啡诺0.5mg+吗啡2mg+0.25%布比卡因+生理盐水稀释到6ml,硬膜外镇痛泵维持量采用布托啡诺1.5mg+吗啡6mg+0.125%布比卡因+生理盐水稀释到100ml,给药速度2ml/h;C组:镇痛首剂采用吗啡2mg+0.25%布比卡因+生理盐水稀释到6ml,硬膜外镇痛泵维持量采用吗啡6mg+0.125%布比卡因+生理盐水稀释到100ml,给药速度2ml/h。观察术后48h内产妇皮肤瘙痒、恶心、呕吐、呼吸抑制、视觉模拟评分(VAS)、Ramsay镇静评分、眩晕等不良反应的发生率。结果①术后48h内皮肤瘙痒发生率:B组(10%)与C组(53.3%)比较明显减少(P<0.05);②视觉模拟评分(VAS):B组比C组明显降低(P<0.05);③Ramsay镇静评分:B组比C组明显增高(P<0.05);④术后24h恶心呕吐发生率:B组(6.7%)与C组(33.3%)比较明显减少(P<0.05)。结论酒石酸布托啡诺在预防术后硬膜外镇痛的皮肤瘙痒效果肯定,而且可增强术后镇痛效果,降低术后恶心呕吐发生率。

Objective To observe the effect of butorphanol tartrate for prevention of itching in postoperative epidural analgesia with morphine after caesarean section. Methods 60 patients （ ASA Ⅰ - Ⅱ ） scheduled for postoperative epidural analgesia were divided into two groups randomly ： Group B （ Butorphanol, n = 30 ） and Group C （Control, n = 30）. Loading dose was administered at 5 minutes after the fetus out. Analgesia formula was as follows（ 1 ） Group B, 0. 25% bupivaeaine plus hutorphanol 0. 5 mg and morphine 2 mg for loading dose; 0. 125%bupivacaine plus butorphanol 1.5 mg and morphine 6 mg for continuous dose. （2）Group C：0. 25% bupivacaine plus morphine 2 mg for loading dose;0. 125% bupivacaine plus morphine 6 mg for continuous dose. The background infusion flow of analgesic were set of 1 ml/h in both groups above. PCA dos（0. 5 ml） was administered as required by the patients for supplemental analgesia with 15 min lockout. The incidence rate of itching, PONV （ past-operative nausea and vomiting）, respiratory depression, VAS score, ramsay sedation score, and vertigo were observed in 48 hours postoperatively. Results ①The incidence rate of itching in group B was 10% ,which was significantly lower（P 〈0. 05） than that in group C（53.5% ）. ②The VAS score of group B was significantly lower than group C （ P 〈 0. 05 ）. ③The Ramsay sedation score of group B was significantly higher than group C （ P 〈0. 05 ）. （4） The incidence rate of PONV in groulb B （ 6. 7 % ） was significantly lower than that in group C （33. 3% ）and group T（26. 7% ）. Conclusion Butorphanol tartrate can prevention the itching in postoperative epidural analgesia with morphine after caesarean section,it can also improve the analgesic effect, decrease the rate of PONV.