不同浓度甲磺酸罗哌卡因复合布托啡诺用于剖宫产术后硬膜外镇痛的临床研究

发布时间：2018-11-25 16:03

【摘要】：目的通过试验归纳总结出甲磺酸罗哌卡因配伍酒石酸布托啡诺用于剖宫产术后硬膜外镇痛的最佳药物浓度,以便为临床实际工作提供参考。方法选取部分需进行剖宫产的足月孕妇,随机分为三组,均施行腰硬联合麻醉,手术后各组分别配带不同浓度甲磺酸罗哌卡因复合酒石酸布托啡诺药液的硬膜外镇痛泵,按时进行跟踪访视,分别在术后4 h、8 h、12 h、24 h、48h进行镇痛、舒适程度和运动阻滞评分测定。同时观察比较各种不良副反应如恶心呕吐、皮肤搔痒、呼吸抑制等的情况。通过对手术后镇痛评级的数据分析,总结出哪种浓度的甲磺酸罗哌卡因配伍酒石酸布托啡诺药液是产妇硬膜外术后镇痛的最有效剂量。结果本研究对照观察了0.119%,0.238%,0.357%的甲磺酸罗哌卡因辅以0.006%布托啡诺在产妇硬膜外术后镇痛中的使用情况。随着甲磺酸罗哌卡因泵内浓度的持续增高,产妇在安静、子宫收缩和下床活动时的VAS评分均呈降低趋势,说明镇痛效果在逐渐提高。使用0.119%甲磺酸罗哌卡因+0.006%布托啡诺的产妇平静卧床时VAS评分大多低于3分,而子宫收缩和活动时大部分时间VAS大于3分,提示子宫收缩和活动时此种浓度的药液其镇痛作用是不够完美的;而使用甲磺酸罗哌卡因0.238%--0.357%的药液时,产妇无论在子宫收缩、活动或者安静时其镇痛效果都较满意,同时对下肢影响较小,产妇很少抱怨下肢麻木。结论综合考虑术后镇痛的效果、患者的舒适程度、下肢运动阻滞情况和副反应的发生率,表明剖宫产术后采取硬膜外镇痛方式时,使用0.238%-0.357%的甲磺酸罗哌卡因配伍0.006%布托啡诺较为适宜。
[Abstract]:Objective to summarize the best drug concentration of ropivacaine mesylate combined with butorphenol tartrate for epidural analgesia after cesarean section. Methods some full-term pregnant women who needed cesarean section were randomly divided into three groups. All of them were given combined spinal-epidural anesthesia. Each group was given epidural analgesia pump with different concentrations of ropivacaine mesylate and butorphanol tartrate after operation. Follow-up visits were conducted on time, analgesia, comfort degree and motor block score were measured at 4 h, 8 h, 12 h, 24 h and 48 h after operation. Side effects such as nausea, vomiting, itchy skin, and respiratory inhibition were also observed and compared. By analyzing the data of postoperative analgesia, we conclude which concentration of ropivacaine mesylate combined with butorphenol tartrate is the most effective dose for epidural analgesia. Results the analgesic effect of 0.238% ropivacaine mesylate plus 0.006% butorphanol on epidural analgesia was observed. With the continuous increase of ropivacaine mesylate pump concentration, the VAS scores of pregnant women in quiet, uterine contraction and out of bed activities showed a decreasing trend, indicating that the analgesic effect was gradually improved. The VAS scores of the pregnant women who received 0.119% ropivacaine mesylate 0.006% butorphenol were lower than 3 when they were still in bed, while the VAS score was greater than 3 when the uterus contracted and moved most of the time. The results suggest that the analgesic effect of this concentration is not perfect. When ropivacaine mesylate (0.238-0.357%) was used, the analgesic effect of parturient was satisfactory in uterine contraction, movement or quiet, and had little effect on lower extremity, and the puerpera seldom complained about lower limb numbness. Conclusion considering the effect of postoperative analgesia, the comfort of patients, the motor block of lower extremity and the incidence of side effects, it is suggested that epidural analgesia should be adopted after cesarean section. It is suitable to use 0.238%-0.357% ropivacaine mesylate and 0.006% butorphanol.
【学位授予单位】：青岛大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R614

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