剖宫产术应用静脉泵注不同剂量布托啡诺复合硬膜外吗啡对术后疼痛的影响

Effect of cesarean section intravenous infusion of different doses of butorphanol epidural morphine for postoperative pain

目的观察剖宫产术应用静脉泵注不同剂量布托啡诺与硬膜外吗啡对产妇术后疼痛的影响,同时观察使用期间不良反应情况,从而为剖宫产术后患者镇痛提供参考。方法将本院2013年12月至2014年12月74例ASAⅠ~Ⅱ级拟行剖宫产术产妇按照随机分组为对照组（术后输注生理盐水）与甲、乙、丙组,分别泵注8、10、12mg布托啡诺;手术结束时均给予硬膜外吗啡2mg推注;然后采用静脉镇痛泵实施自控静脉镇痛。采用视觉模拟法（VAS）评分评价各组产妇术后不同时点（4、12、24、36、48小时）疼痛情况,统计各组自控镇痛次数及不良反应发生情况。结果甲、乙、丙3组于术后24、36、48小时VAS评分及术后24、36、48小时自控镇痛次数明显低于对照组,P〈0.05;乙、丙组于术后24、36、48小时VAS评分及术后24、36小时自控镇痛次数明显低于甲组,P〈0.05。各组产妇所发生的不良反应率比较,P〈0.05。结论剖宫产术后应用硬膜外推注2mg吗啡联合静脉泵注200ug/h具有显著镇痛效果且安全。

objective To observe the effect of analgesic methods by intravenous infusion with different doses of butorphanol combined with epidural morphine in patients undergoing cesarean section through comparing the postoperative pain and adverse reaction, and to provide a reference analgesic method to patient after cesarean section. Methods December 2013-December 2014 in our hospital, 74 cases which ASA Ⅰ-Ⅱ grade and undergoing cesarean section were randomly divided into the control group（infusion with saline post operation）and the Group A,Group B,Group C（infusion respectively 8mg, 12 mg, 14 mg butorphanol）. All patients were given epidural injection with 2mg morphine at the end of surgery, and self-con-trol intravenous analgesia were applied. The post-operation pain degree were evaluated by visual analog scores（VAS） at different time after surgery（4h, 12 h, 36 h, 48h）. The number of self-controlled analgesia and adverse events were also recorded. Results AThe VAS and the number of selfcontrolled analgesia in group A, group B, group C at the time of postoperation 24 h, 36 h, 48 h were significantly lower than those in the control group（P〈0.05）. The VAS in group B, group C at the time of postoperation 24 h, 36 h, 48 h, and the number of self-controlled analgesia in group B, group C at the time of postoperation 24 h, 36 h were significantly lower than those in group A（ P〈0.05）. Adverse reaction rates in each groups had statistical sig-nificant differences（P〈0.05）. Conclusion Analgesic method by intravenous infusion with 240ug/h butorphanol combined with epidural 2mg mor-phine in patients undergoing cesarean section was proved to be effect and safety.