不同浓度喷他佐辛复合左旋布比卡因对剖宫产术后镇痛效应和不良反应的影响

DOSE-EFFECT OF CO-ADMINISTERED PENTAZOCINE AND LEVOBUPIVACAINE ON POSTCESAREAN ANALGESIA

目的:研究不同浓度喷他佐辛复合0.2%左旋布比卡因对产妇剖宫产术后硬膜外自控镇痛(PCEA)效应和不良反应的影响。方法:120例择期行剖宫产初产妇(ASA I^II级),随机分成六组(n=20),P1组:0.1%喷他佐辛复合0.2%左旋布比卡因,P2组:0.12%喷他佐辛复合0.2%左旋布比卡因,P3组~P6组分别给予0.14%、0.16%、0.18%、0.2%喷他佐辛复合0.2%左旋布比卡因,各组镇痛药液总量共100ml。均采用LCP模式给药:负荷剂量5ml,背景剂量2ml.h-1,单次追加剂量2ml,锁定时间15min,镇痛24h。观察和记录术后第1h、2h、4h、8h、16h及24h的静息疼痛、动态疼痛、子宫收缩痛VAS评分,PCA泵的按压次数(D1)及实际有效次数(D2),Ramesay镇静评分,改良Bromage分级,肛门排气时间及可能发生的不良反应。结果:六组产妇术后各时点静息镇痛效果良好,各组随着喷他佐辛的剂量增大而VAS评分降低,即P1组≈P2组>P3组≈P4组>P5组≈P6组,其中动态疼痛及宫缩痛术后4h、8h及16h明显降低;PCA按压次数及D1/D2比值P5组和P6组小于P1组~P4组(P<0.05);六组产妇中恶心发生情况:P1组、P2组、P4组及P6组各1例(5%),P3组及P5组各2例(10%),(P>0.05),各组未出现呕吐、瘙痒、呼吸抑制、低血压或高血压等不良反应。结论:0.18%或0.2%喷他佐辛复合0.2%左旋布比卡因用于产妇剖宫产术后PCEA的效果良好,优于0.1%、0.12%、0.14%或0.16%喷他佐辛复合0.2%左旋布比卡因,不良反应未见增加;可作为剖宫产术后首选镇痛方案之一。

Objective：To study the effect of different dose of pentazocine combined with levobupivacaine on postcesarean analgesia.Methods：120 ASA Ⅰ or Ⅱ parturient women undergoing cesarean section received PCEA for 24h after operation.The PCEA solution contained 0.2% levobupivacaine plus pentazocine 1.0,1.2,1.4,1.6,1.8 or 2.0mg·ml-1（group P1,P2,P3,P4,P5,P6,n=20）.The epidural PCA device was set up to deliver a 2ml bolus dose with a 15-min lockout interval and background infusion at 2ml·h-1 after a loading dose of 5ml.The following parameters were recorded at 1,2,4,8,16,24 h after pump infusion：the VAS score of rest pain,dynamic pain and uterine continuous pain,the times of self administration bolus（D1） and effective times（D2）,Ramsay sedation score,modified Bromage score,BP,HR,RR,SpO2 and side effects.Results：The pain scores of parturients in group P1 and P2 were higher than those in the group P3 and P4,which were higher than those in the group P5 and P6,in short,group P1≈P2P3≈P4P5≈P6,the differences were statistically significant at 4,8,16h.The times of D1 and the D1/ D2 ratio of group P5 and P6 were the smallest in 6 groups（P0.05）.The incidences of PONV is 5% in group P1,P2,P4,P6,and 10% in group P3 and P5（P0.05）.Conclusions：0.18% or 0.2% pentazocine