布托啡诺与曲马多复合罗哌卡因用于剖宫产术后硬膜外镇痛的效果分析

Effect of butrophanol and tramadol combined with ropivacaine on PCEA after cesarean

目的比较观察布托啡诺与曲马多分别复合罗哌卡因用于剖宫产术后硬膜外自控镇痛的效果及对催乳素的影响。方法选择160例择期行剖宫产的孕妇,随机分为布托啡诺组(B组)和曲马多组(T组),术毕行PCEA48h,B组为0.15%罗哌卡因+40μg/mL布托啡诺,T组为0.15%罗哌卡因+4mg/mL曲马多。观察记录两组孕妇的VAS评分、总用药量、Bonus次数、Ramsay评分、不良反应发生情况及血清催乳素浓度变化。结果 T2-T5时点B组VAS评分低于T组(P<0.05),B组总用药量及Bonus次数均小于T组(P<0.05),T2-T5时点T组Ramsay评分高于B组(P<0.05),两组均无严重并发症发生,T组恶心、呕吐发生率高于B组(P<0.05),两组术后24及48h血清PRL浓度均高于术前(P<0.05),组间比较无差异(P>0.05)。结论布托啡诺与曲马多分别复合罗哌卡因用于剖宫产术后硬膜外自控镇痛均安全有效,且不良反应较少,布托啡诺复合罗哌卡因的镇痛效果优于曲马多,且镇静程度较曲马多浅,恶心、呕吐发生率较低。

【Objective】To analyze the analgesia effect and influence to PRL of butrophanol and tramadol used for PCEA combined with ropivacaine after cesarean.【Methods】A total of 160 cases with selective cesarean were divided into butrophanol group（group B） and tramadol group（group T） randomly.After surgery 48 h PCEA was done,group B was given 0.15% ropivacaine ＋ 40 μg/mL butrophanol,while group T was given 0.15% ropivacaine ＋ 4 mg/mL tramadol.VAS score,total dosage,bonus time,Ramsay score,adverse effect occurrence and concentration changes of serous PRL were observed.【Results】T2-T5 VAS scores of group B were lower than those of group T（P〈0.05）.Total dosage and bonus time of group B were also lower（P〈0.05）,T2-T5 Ramsay scores of group B were lower（P〈0.05）.Serious complications were not observed.Incidence of nausea and vomiting of group T was higher than that of group B（P〈0.05）.Postoperative concentrations of serous PRL in both groups were higher than preoperative ones.【Conclusions】Butrophanol and tramadol combined with ropivacaine used for PCEA after cesarean are both safe and effective with few adverse effects,analgesia effect of butrophanol is stronger than that of tramadol,with milder sedative effect and lower incidence of nausea and vomiting.