酒石酸布托啡诺和氟比洛芬酯预防硬膜外阻滞下剖宫产术中宫缩痛的临床观察

A comparative study on the preventive effect of medication on contraction pain during cesarean section under epidural anesthesia

目的观察酒石酸布托啡诺和氟比洛芬酯预防和治疗硬膜外阻滞剖宫产手术过程中的宫缩痛的临床效果。方法采用前瞻性研究方式选取同济大学附属上海市第一妇婴保健院自2017年1月至4月收治的90例美国麻醉医师协会(ASA)分级Ⅰ～Ⅱ级单胎、足月经产妇和初产妇作为研究对象,按照随机平行分组法随机分为三组,选L_(1～2)或L_(2～3)行硬膜外穿刺术,连续推注1. 73%碳酸利多卡因+1:2 000 000肾上腺素13～16 ml。控制麻醉平面T_6以下,在胎儿娩出脐带切断后Ⅰ组静脉推注酒石酸布托啡诺1 mg,Ⅱ组静脉推注氟比洛芬酯50 mg,Ⅲ组(对照组)静脉推注0. 9%氯化钠溶液1 ml。比较三组产妇各时间点MAP、SpO_2、HR、术中出血量、宫缩痛疼痛视觉模拟评分(VAS)情况并观察不良反应。结果三组产妇手术开始(T1)、娩出后即静脉注药后(T2)、手术结束时(T3)的MAP、SpO_2、HR及术中出血量差异无统计学意义(P> 0. 05);Ⅰ组、Ⅱ组、Ⅲ组组间不同时间点VAS评分比较,差异有显著性(P <0. 05),Ⅰ组、Ⅱ组治疗宫缩痛效果好,Ⅰ组效果优于Ⅱ组(P <0. 05);Ⅰ组不良反应发生率明显高于Ⅱ、Ⅲ组,差异有显著性(P <0. 05)。结论预防性给予酒石酸布托啡诺、氟比洛芬酯静脉注射可以预防和治疗硬膜外阻滞下剖宫产术过程中的宫缩痛。

Objective To observe the clinical effect of butophanol tartrate and flurbiprofen axetil in prevention and treatment of uterine contraction pain during cesarean section under epidural block.Methods This is a prospective study on 90 cases with ASA grade I^II,single fetus,full menstrual maternal and primipara in this hospital during January to April,2017 as study objects,they were divided into 3 groups according to randomized parallel grouping method,L 1~2 or L 2~3 for epidural puncture,continuous infusion of 1.73%lidocaine epinephrine 13+1:2000000~16 ml.The control level of anesthesia under T 6 in fetus umbilical cord in group I after intravenous injection of butorphanol tartrate 1 mg,group II intravenous injection of flurbiprofen 50 mg(control group)with intravenous injection of 0.9%sodium chloride solution 1 ml.The MAP,SpO 2,HR,volume of intraoperative bleeding and VAS of uterine contraction pain were compared between these 3 groups at different time points.Results Starting of operation(T1),vein injection immediately after delivery(T2),at the end of surgery(T3),MAP,SpO 2,HR,there was no significant difference in the amount of bleeding(P>0.05).In group I,group II,and group III between different time points of VAS scores(P<0.05)in group I,and group II for,treatment of uterine contraction pain,the effect of group I was better than that of group II(P<0.05).There was significant difference in incidence of adverse reactions between these 3 groups(P<0.05).Conclusion Prophylactic administration of butophanol tartrate and flurbiprofen axetil can prevent and treat uterine contraction pain during cesarean section under epidural block.