【作者】 黄强；

【导师】 陶明哲；

【作者基本信息】 暨南大学 ， 麻醉学， 2010， 硕士

【摘要】 目的：探讨布托啡诺对剖宫产术后硬膜外吗啡镇痛副作用的预防效果。方法：选择硬膜外麻醉下行剖宫产手术的产妇90例,ASAⅠ～Ⅱ级,随机分为3组各30例进行双盲对照研究。胎儿娩出后,B组予lmg布托啡诺、D组予10mg地塞米松、N组予2ml生理盐水经莫菲氏壶静注。3组术毕均采用负荷量加连续量患者自控硬膜外镇痛（PCEA）技术进行术后镇痛：PCEA药液总量100ml,内含吗啡4mg、布比卡因150mg和生理盐水；负荷量含吗啡2mg,背景输注量为2ml／h,单次按压量为1.0ml／次,锁定时间为15min。术中、术后连续监测BP、RR、ECG、SpO₂,观察统计指标：①镇痛指标：48h内各时间点的视觉模拟评分（VAS）,需要患者自控镇痛（PCA）按压的病例数和每100m]镇痛药液维持的总时间；②吗啡常见副作用：恶心呕吐、瘙痒发生率和程度,呼吸抑制发生情况；③满意度指标：舒适度评级（BCS）和主观满意度评级。结果：①镇痛作用评价：三组患者术后镇痛效果良好,各时间点VAS评分组间比较差异无统计学意义（P>0.05）；B组患者需要按压PCA的例数明显少于D组、N组（P<0.05）,100ml镇痛药液维持的时间B组也长于D组、N组（P<0.05）。②副作用发生率：恶心呕吐发生率,B、D两组（13.3%和20.0%）明显低于N组（46.7%）,其差异有统计学意义（P<0.01,P<0.05）,而B组与D组的差异无统计学意义（P>0.05）；瘙痒的发生率,B组和D组（6.7%和16.7%）基本相当（P>0.05）,它们均明显低于N组（53.3%）（P<0.01）；呼吸抑制发生率,三组患者均没有发生呼吸抑制情况。③满意度评价：B组患者的满意度明显高于其它两组患者（P均<0.05）结论：1mg布托啡诺术中静脉输注,能显著降低硬膜外吗啡术后镇痛期剖宫产患者恶心、呕吐及瘙痒的发生率,不增加其呼吸抑制,能明显提高患者的术后舒适性和对麻醉、术后镇痛的满意度。更多还原

【Abstract】 Objective:To evaluate the effect of butorphanol for preventing the side-effects of epidural morphine after Cesarean section.Methods:90 patients(ASA I-II) undergoing Cesarean section were enrolled in a randomized double-blinded study.All the patients received patient-controlled eidural analgesia (PCEA) with the analgetic solution of 0.15%bupivacaine 100ml which contains morphine 4mg.The PCEA were programmed with a loading dose of additional morphine 2mg,background infusion 2ml/h and a bolus dose 1.0ml, the lockout time is 15min.After the delivery,1mg butorphanol IV in group B(n=30); l0mg dexamethasone IV in group D(n=30); and 2ml saline were used as control in group N(n=30),all these were given through the Murphy’s Dropper. BP,RR, ECG and SpO2 of all the patients were monitored continuously during the operation; VAS Scores were observed timely, the cases that need to press the PCA button,and the analgesia time of each patient were noted;the cases and severity of PONV and pruritus, the BCS and the degree of satisfaction with analgesia of all the patients were recorded at the end of analgesia.Results:①All the patients of the three groups got satisfaction analgetic effect, there were no significant difference in VAS among the three groups(P>0.05);but we notice in group B, the cases need to press the PCA button were less than other two groups (P＜0.05),the analgesia time of 100ml solution also last longer in group B than other two groups (P<0.05).②The cases of nausea and vomiting in group B and group D were obviously less than that in group N(P<0.01, P<0.05),between the group B and group N,there were no significant difference;the cases of pruritus in group B and group D was obviously less than that in group N(P<0.01),between the group B and group N,there were no significant difference; all the three groups had no respiratory depression.③The BCS scores in group B and group D were obviously higher than that in group N(P<0.01),and the score in group B was higher than group D, too(P<0.05).The patients of group B got more satisfaction with analgesia among the three groups, (P<0.05).Conclusion:The butorphanol is effective in preventing PONV and pruritus associated with morphine during PCEA., without increasing the respiratory depression; And it can make patient feel more comfortable and satisfaction.更多还原