摘要
目的:评估艾司氯胺酮、布托啡诺对剖宫产产妇吗啡硬膜外注射所致术后不同时限瘙痒的影响。方法:选取台州市中心医院(台州学院附属医院)妇产科行连续硬膜外麻醉下择期剖宫产手术的产妇162例,随机分为艾司氯胺酮组(K组)、布托啡诺组(B组)和空白对照组(C组)。待胎儿剖出断脐5 min后,K组予以3 mg吗啡稀释液经硬膜外导管注射,同时静脉注射艾司氯胺酮0.2 mg/kg,B组、C组予以相同剂量吗啡,同时分别静脉注射布托啡诺10μg/kg或同体积生理盐水。比较三组产妇术后不同时间瘙痒发生率、瘙痒程度和其他不良反应发生率。结果:产妇瘙痒在术后4 h内发生率最高。K组和B组产妇术后4 h瘙痒发生率明显低于C组(3.7%vs.3.7%vs.29.6%,P<0.05),术后48 h瘙痒总发生率明显低于C组(13.0%vs.11.1%vs.40.7%,P<0.05),且中重度瘙痒发生率也明显低于C组(5.6%vs.3.7%vs.31.5%,P<0.05);而K组与B组间比较差异均无统计学意义(均P>0.05)。三组产妇术后恶心、呕吐、头晕的发生率和术后疼痛评分比较差异均无统计学意义(均P>0.05)。结论:艾司氯胺酮、布托啡诺均可降低产妇吗啡硬膜外注射所致瘙痒的发生率及瘙痒程度,不影响吗啡镇痛效果且未增加不良反应发生率。艾司氯胺酮对剖宫产术后瘙痒的预防效果、安全性与布托啡诺相当。
AIM:To evaluation the effects of esketamine and butorphanol on postoperative pruritus induced by epidural morphine injection in cesarean delivery parturients.METHODS:A total of 162 parturients who underwent elective cesarean section under continuous epidural anesthesia in Taizhou Central Hospital(Taizhou University Hospital),were selected and randomly divided into esketamine group(group K),butorphanol group(group B)and blank control group(group C).5min after umbilicus amputation,parturients in group K was injected with 3 mg morphine diluent through epidural catheter,and esketamine 0.2 mg/kg intravenously.Parturients in groups B and C were given the same dose of morphine,and butorphanol 10μg/kg or the same volume of normal saline,respectively.The incidence of postoperative pruritus at different times,the degree of pruritus and incidence of other adverse reactions were compared among three groups.RESULTS:The highest incidence of pruritus occurred within 4 hours after operation.The incidence of postoperative pruritus at 4 hours in group K and B was significantly lower than that in group C(3.7%vs.3.7%vs.29.6%,P<0.05),the total incidence of postoperative pruritus within 48 hours was also significantly lower than that in group C(13.0%vs.11.1%vs.40.7%,P<0.05),and the incidence of moderate to severe pruritus was also significantly lower than that of group C(5.6%vs.3.7%vs.31.5%,P<0.05).There was no significant difference between group K and group B(all P>0.05).There were no significant differences in the incidence of postoperative nausea,vomiting,dizziness and postoperative pain scores among three groups(P>0.05).CONCLUSION:Both esketamine and butorphanol can reduce the incidence and degree of pruritus caused by epidural morphine injection in parturients,without affecting the analgesic effect of morphine and without increasing the incidence of adverse reactions.Esketamine is as effective and safe as butorphanol in preventing pruritus after cesarean section.
作者
冯艳
李高炜
金琪琪
蔡伟茶
林学正
李军
FENG Yan;LI Gaowei;JIN Qiqi;CAI Weicha;LIN Xuezheng;LI Jun(Department of Anesthesiology and Perioperative Medicine,the Second Affiliated Hospital&Yuying Children's Hospital,Wenzhou Medical University,Wenzhou 325027,Zhejiang,China;Department of Anesthesia and Surgery,Taizhou Central Hospital(Taizhou University Hospital),Taizhou 318000,Zhejiang,China)
出处
《中国临床药理学与治疗学》
CAS
CSCD
2022年第12期1425-1430,共6页
Chinese Journal of Clinical Pharmacology and Therapeutics
基金
重大新药创制国家科技重大专项(2020ZX09201002)。
关键词
艾司氯胺酮
布托啡诺
剖宫产
产妇
术后瘙痒
esketamine
butorphanol
cesarean section
parturients
postoperative pruritus