酒石酸布托啡诺静脉自控镇痛对母婴安全的影响

Effects of butorphanol tartrate on maternal and infant during labor analgesia

目的 探讨κ-阿片肽受体激动剂酒石酸布托啡诺用于分娩镇痛的有效性及安全性.方法 选择80例产妇,均足月、头位、单胎,19~38岁,ASA Ⅰ~Ⅱ级,一般情况良好,自愿要求实施分娩镇痛.随机分为布托啡诺组（按布托啡诺用药浓度的不同分为3组.A组：0.06%;B组：0.08%;C组：0.1%）和对照组（D组：不选择分娩镇痛,未经任何镇痛药物干预）,每组20例.观察并记录VAS（视觉模拟镇痛）评分、新生儿Apgar评分、产妇不良反应,同时抽取母体外周静脉血和新生儿脐带动脉混合血检测布托啡诺血药浓度及β-内啡肽（β-EP）的浓度.结果 布托啡诺组VAS评分在整个产程进展中明显低于对照组（P〈0.01）,组内比较,B、C组VAS评分低于A组（P〈0.05）;布托啡诺组新生儿Apgar评分与对照组比较差异无统计学意义（P〉0.05）;布托啡诺组产妇镇静表现高于对照组（P〈0.05）,组内比较,A、B组镇静表现低于C组（P〈0.05）;布托啡诺组新生儿脐带动脉混合血的血药浓度明显低于母体静脉血的血药浓度（P〈0.05）;布托啡诺组外周静脉血β-EP浓度明显低于对照组（P〈0.05）.结论 酒石酸布托啡诺因其独有的κ受体激动与μ受体拮抗作用,在完善镇痛的同时,避免了很多阿片类药物的各种不良反应,0.08%布托啡诺用于静脉分娩镇痛,镇痛效果好,对母婴安全无明显影响,值得临床推广研究.

Objective To observe the effectiveness and safety of K-opioid receptor agonist butorphanol tartrate on intravenous analgesia. Methods 80 cases of full-term, head, singleton, 19 - 38 year-old, ASA I - 1I, in general good condition and voluntarily to implement maternal analgesia in labor were chosen. The patients were randomly divid- ed into butorphanol tartrate group （classified according to different butorphanol tartrate drug concentration into three groups, group A ：0. 06% ;group B ：0. 08 % ; group C ：0. 1% ） and control group （group D：did not choose labor analge- sia, without any analgesia drug intervention ）, 20 cases in each group. The VAS score, neonatal Apgar score, adverse maternal performance were observed and recorded, at the same time, venous blood and umbilical artery blood were ex- tracted from maternal peripheral to detect mixed butorphanol tartrate and serum concentration of fl-endorphin （β-EP）.Results The VAS score of butorphanol tartrate group was significantly lower than that of control group in the progress of the whole production process （P 〈 0. 01 ） , and the scores in group B, group C were lower than those in group A （P 〈 0. 05 ） ;there was no significant difference in Apgar score of neonates between butorphanol tartrate group and control group （ P 〉 0. 05 ） ; the maternal sedation of butorphanol tartrate group was higher than that of control group （ P 〈 0. 05 ） , the sedation ability of group A and group B was lower than that of group C （ P 〈 0. 05 ） ; the blood concentration of neonatal umbilical artery mixed blood of butorphanol tartrate group was significantly lower than that of maternal ve- nous blood （ P 〈 0. 05 ） ; the peripheral venous blood fl-EP concentration of butorphanol tartrate group was significantly lower than that of control group （ P 〈 0. 05 ）. Conclusion Due to its unique K-receptor activation and ix-receptor an- tagonism ,butorphanol tartrate avoids the side effects of many opioids during perfect analgesia ;0. 08% butorphanol tar- trate has a good effect on vein labor analgesia, with no obvious effect on maternal and infant safety, and it is worthy of further clinical research.