布托啡诺联合小剂量纳美芬在二次剖宫产术后镇痛中的应用

Application of butorphanol with low dose nalmefene in postoperative analgesia after second cesarean section

关键词:  布托啡诺  纳美芬  剖宫产  术后镇痛  不良反应

Key words:  butorphanol  nalmefene  cesarean section  postoperative analgesia  adverse reaction

摘要:

目的 观察布托啡诺联合小剂量纳美芬对二次剖宫产术后镇痛效果的影响。方法 选择90例孕足月产妇，随机分为3组（n=30），术后镇痛泵配方分别为：B组：布托啡诺0.15 mg/kg；BN1组：布托啡诺0.15 mg/kg+纳美芬0.25 μg/kg；BN2组：布托啡诺0.15 mg/kg+纳美芬0.5 μg/kg。各组均用0.9%生理盐水稀释到100 mL。记录术中用药以及液体出入量，术后2 h、6 h、24 h、44 h的切口痛和宫缩痛视觉模拟评分（visual analogue score，VAS），镇痛泵追加次数以及不良反应。结果 BN2组术后各时间点宫缩痛VAS评分均比B组降低明显（P<0.05）；BN2组嗜睡这一不良反应的发生率较B组明显减少（P<0.05）；BN1组术后各时间点宫缩痛VAS评分和嗜睡的不良反应均介于B组与BN2组之间，但与二者相比差异无统计学意义；3组切口痛VAS评分、镇痛泵追加次数以及其他不良反应的发生率差异无统计学意义（P>0.05）。结论 0.5 μg/kg的纳美芬联合布托啡诺可以减轻布托啡诺嗜睡，还可以增强对宫缩痛的抑制作用。

Abstract:

Objective To observe the effect of butorphanol with low dose nalmefene on analgesia after second cesarean section. Methods Ninety pregnant women with second cesarean section were randomly divided into three groups (n=30). The postoperative analgesia pump formulations were: butorphanol 0.15 mg/kg in group B, butorphanol 0.15 mg/kg+nalmefene 0.25 μg/kg in group BN1, and butorphanol 0.15 mg/kg+nalmefene 0.5 μg/kg in group BN2. Each group was diluted to 100 mL with 0.9% saline. The intraoperative medication, fluid intake and outflow, visual analogue score of incision pain and contractile pain at 2 h, 6 h, 24 h and 44 h after surgery, times of additional analgesic pump and adverse reactions were recorded. Results Compared with group B, VAS score of contractile pain significantly decreased in group BN2 at 2 h, 6 h, 24 h and 44 h after operation (P<0.05) and the incidence of sleepiness in BN2 group was significantly lower (P<0.05).The VAS score of contractile pain and side effects of drowsiness in the BN1 group at each postoperative time point were distributed between the B group and the BN2 group, but they were not significantly different. The VAS score of incisive pain, the times of adding analgesic pump and the occurrence of other adverse reactions had no significant difference among three groups. Conclusion Butorphanol with 0.5 μg/kg nalmefene may reduce the adverse effect of drowsiness and enhance its inhibitory effect on contractile pain.