布托啡诺联合罗哌卡因术后硬膜外镇痛对剖宫产后产妇血儿茶酚胺及血流动力学的影响

Effect of Butorphanol Combined with Ropivacaine on Postoperative Epidural Analgesia on Parturients Undergoing Cesarean Section

目的:探讨布托啡诺联合罗哌卡因术后硬膜外镇痛对剖宫产产妇的影响。方法:选取2020年3月-2021年6月佛山市南海区桂城医院收治的120例剖宫产产妇为研究对象。按照随机数字表法将其分为布托啡诺组、罗哌卡因组、联合用药低剂量组、联合用药高剂量组,每组30例。布托啡诺组给予0.008%布托啡诺镇痛,罗哌卡因组给予0.15%罗哌卡因镇痛,联合用药低剂量组给予0.1%罗哌卡因+0.006%布托啡诺混合液镇痛,联合用药高剂量组给予0.125%罗哌卡因+0.007%布托啡诺混合液镇痛。比较四组自控镇痛情况,术后2、12、24 h的疼痛程度及生命体征,术后12 h应激指标及下肢运动神经阻滞程度,不良反应。结果:联合用药高剂量组术后24 h内自控镇痛次数少于布托啡诺组、罗哌卡因组和联合用药低剂量组(P<0.05)。术后2、12 h,联合用药高剂量组视觉模拟评分法(VAS)评分低于布托啡诺组、罗哌卡因组和联合用药低剂量组(P<0.05)。联合用药高剂量组术后12 h的肾上腺素(E)、去甲肾上腺素(NE)及多巴胺(DA)水平均低于布托啡诺组、罗哌卡因组和联合用药低剂量组(P<0.05)。术后2、12 h,联合用药高剂量组心率(HR)、舒张压(DBP)及收缩压(SBP)均低于布托啡诺组、罗哌卡因组和联合用药低剂量组(P<0.05)。四组不良反应发生率比较差异无统计学意义(P>0.05)。结论:0.125%罗哌卡因+0.007%布托啡诺联合用药硬膜外镇痛有助于减轻剖宫产术后疼痛,降低儿茶酚胺水平,维持产妇血流动力学稳定,且安全性良好。

Objective:To explore the effect of Butorphanol combined with Ropivacaine on postoperative epidural analgesia on parturients undergoing cesarean section.Method:A total of 120 cases of cesarean section parturients admitted to Guicheng Hospital of Nanhai District,Foshan City from March 2020 to June 2021 were selected as the research objects.They were divided into Butorphanol group,Ropivacaine group,combined medication low-dose group and combined medication high-dose group according to the random number table method,with 30 cases in each group.The Butorphanol group was given 0.008%Butorphanol for analgesia,the Ropivacaine group was given 0.15%Ropivacaine for analgesia,the combined medication low-dose group was given 0.1%Ropivacaine+0.006%Butorphanol mixture for analgesia,and the combined medication high-dose group was given 0.125%Ropivacaine+0.007%Butorphanol mixture for analgesia.The patient-controlled analgesia condition,the degree of pain and vital signs at 2,12 and 24 hours after operation,the stress indexes at 12 hours after operation,the degree of lower extremity motor nerve block and adverse reactions were compared among the four groups.Result:The number of patient-controlled analgesia within 24 hours after operation in the combined medication high-dose group was less than that in the Butorphanol group,Ropivacaine group and the combined medication low-dose group(P<0.05).At 2 and 12 hours after operation,the visual analogue scale(VAS)score of the combined medication high-dose group were lower than those of the Butorphanol group,the Ropivacaine group and the combined medication low-dose group(P<0.05).The levels of epinephrine(E),norepinephrine(NE)and dopamine(DA)in the combined medication high-dose group were lower than those in the Butorphanol group,the Ropivacaine group and the combined medication low-dose group 12 h after operation(P<0.05).At 2 and 12 hours after operation,heart rate(HR),diastolic blood pressure(DBP)and systolic blood pressure(SBP)in the combined medication high-dose group were lower than those in the Butorphanol group,Ropivacaine group and the combined medication low-dose group(P<0.05).There was no significant difference in the incidence of adverse reactions among the four groups(P>0.05).Conclusion:The combination medication of 0.125%Ropivacaine and 0.007%Butorphanol for epidural analgesia is helpful to relieve postoperative pain after cesarean section,reduce the level of catecholamines,and maintain the stability of parturients hemodynamics with good safety.