布托啡诺联合曲马多-罗哌卡因用于硬膜外分娩镇痛的临床研究

Clinical Study of Epidural Butorphanol Combined with Tramadol-ropivacaine for Analgesia during Labor

目的：把布托啡诺与曲马多联合用于分娩镇痛，观察其效果、副作用及安全性。方法：足月初产妇共40例，随机分为两组。在宫口开大3～4cm时于腰2～3硬膜外穿刺置管，1％利多卡因4mL做试探剂量，待出现麻醉平面后，布托啡诺组产妇在硬膜外接受布托啡诺1mg（2mL）＋0．05％曲马多与0．15％罗哌卡因混合液8mL；曲马多组接受曲马多100mg（2mL）＋0．05％曲马多与0．15％罗哌卡因混合液8mL。记录用药前、用药后5、10、30min宫缩时疼痛VAS评分、镇静Ramesay评分，新生儿Apgar评分，观察副作用发生率。结果：布托啡诺组在给药后5、10、30minVAS评分都明显低于曲马多组（P〈0．05）；镇静Ramesay评分在给药10min时布托啡诺组明显大于曲马多组（P〈0．05）；恶心、呕吐发生率曲马多组明显大于布托啡诺组。结论：硬膜外1mg布托啡诺与曲马多、罗哌卡因混合液用于分娩镇痛效果好，对新生儿安全，减少副作用的发生。

Objective：To observe the effect and side-effect of epidural butorphanol combined with tramadol for analgesia during labor. Methods：Forty full-term primiparae were selected and randomly divided into two groups. Epidural puncture was executed when cervical dilation came to 3-4 cm. 4 mL of 1 % lidoeaine was used as a test bolus. When anaesthesia segment appeared, 1 mg of butorphanol（2 mL）plus 8 mL of combination solution of 0.05% tramadol and 0.15% ropivaeaine were injected epidural in butorphanol group or 100 mg of tramadol（2 mL）plus same quantity of combination solution of 0.05 % tramadol and 0.15% ropivacaine in tramadol group. VAS scores and Ramsey scores of primiparae before injection and at 5 min, 10 min,30 min after injection, neonate Apgar score as well as the ratio of side effect were recorded. Results：VAS scores at 5 min, 10 min,30 min after injection were significantly lower in butorphanol group than that in tramadol group（P〈0. 05）;Ramsey scores in butorphanol group at 10 min after injection was higher than in tramadol group（P〈0.05） ;the ratio of nausea-vomiting in tramadol group was higher than that in butorphanol group. Conclusion： 1 mg of epidural butrophanol combined with tramadol and ropivacaine used for analgesia during labor is effective, safe for neonate and can reduce side-effect ratio.