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| 持续背景输注不同剂量酒石酸布托啡诺对疤痕子宫产妇再次剖宫产术后疼痛的效果 |
| Effect of continuous infusion of different doses of butorphanol in analgesia after cesarean section with scar uterus |
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| DOI：10.12089/jca.2020.07.007 |
| 中文关键词: 疤痕子宫 产妇 镇痛 布托啡诺 |
| 英文关键词: Scar uterus Maternal Analgesia Butorphanol |
| 基金项目:南京医科大学发展基金面上项目（2017NJMU078） |
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| 中文摘要: |
目的 评估持续背景输注不同剂量酒石酸布托啡诺用于疤痕子宫产妇再次剖宫产术后静脉自控镇痛的效果，探讨较适宜的合理用药剂量。
方法 选择疤痕子宫指征择期行剖宫产产妇180例，年龄22~40岁，体重50~80 kg，ASA Ⅰ或Ⅱ级，采用数字表法将产妇随机分为三组：术后镇痛泵酒石酸布托啡诺含量100 μg/ml（A组），术后镇痛泵酒石酸布托啡诺含量120 μg/ml（B组），术后镇痛泵酒石酸布托啡诺含量140 μg/ml（C组），每组60例。PCIA参数设置：持续背景剂量2.5 ml/h，PCA剂量2 ml，锁定时间20 min。记录术后4、8、12、24、48 h VAS疼痛评分。记录排气时间、泌乳开始时间、产妇满意度评分、术后48 h内镇痛泵有效按压次数。记录术后恶心、呕吐、嗜睡等不良反应的发生情况。
结果 与A组比较，术后8、12、24 h C组VAS疼痛评分明显降低（P<0.05），术后12、24 h B组VAS疼痛评分明显降低（P<0.05）。A组镇痛泵有效按压次数明显多于B组、C组（P<0.05）。B组产妇满意度评分明显高于A组、C组（P<0.05）。三组排气时间、泌乳开始时间差异无统计学意义。三组恶心、呕吐发生率差异无统计学意义，C组头晕、嗜睡发生率明显高于A组、B组（P<0.05）。
结论 疤痕子宫再次剖宫产产妇术后宫缩痛时，120 μg/ml布托啡诺持续背景2.5 ml/h输注，可获得满意的镇痛效果，不增加围产期风险，不良反应发生率较低。 |
| 英文摘要: |
Objective To evaluate the effect of continuous infusion of different doses of butorphanol in the patient-controlled intravenous anagesia after cesarean section with scar uterus, and to explore the appropriate dose.
Methods A total of 180 cases of cesarean section with scar uterus, aged 22-40 years, weighing 50-80 kg, falling into ASA physical statusⅠ or Ⅱ, were randomly divided into three groups (n = 60)， the content of butorphanol tartrate in postoperative analgesia pump was 100 μg/ml (group A), 120 μg/ml (group B), 140 μg/ml (group C), according to the random number table, PCIA parameter setting: continuous administration of background dose 2.5 ml/h, PCA amount 2 ml, lock time 20 min. The VAS scores at 4, 8, 12, 24, and 48 h after surgery of three groups were recorded. The times of self-controlled PCA additions, time to flatus, time to lactation, maternal satisfaction score and adverse reactions were observed and recorded.
Results The VAS scores of group C was significantly lower than those of group A from 8, 12, 24 h after operation(P < 0.05). The VAS scores of group B was significantly lower than that of group A at 12, 24 h postoperatively (P < 0.05). The number of PCA compressions in group A was higher than the other two groups in the postoperative time (P < 0.05). The incidence of nausea and vomiting in three groups had no significant difference. The rate of sleepiness in group C was significantly higher than that in group A and group B (P < 0.05). The maternal satisfaction score in group B was the highest among three groups (P < 0.05)． There was no significant difference in flatus time and lactation time in all groups.
Conclusion Continuous infusion of butorphanol in the concentration of 120 μg/ml at the rate of 2.5 ml/h can provide satisfactory analgesia for puerperant after cesarean section with scar uterus with no increasing risks and a lower incidence of adverse reacton. |
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