不同剂量布托啡诺复合硬膜外分娩镇痛对产妇产程及镇痛效果的影响

Effects of different doses of butorphanol combined with epidural analgesia on stages of labor and analgesic effect in parturients

摘要:

目的 探讨不同剂量布托啡诺复合硬膜外分娩镇痛对产妇产程及镇痛效果的影响。方法 选取2022年10月—2023年10月常州市妇幼保健院分娩的188例产妇作为研究对象，通过随机数字表法分为4组：A组使用9.75 mL 0.125%罗哌卡因+0.25 mL布托啡诺，B组使用9.50 mL 0.125%罗哌卡因+0.50 mL布托啡诺，C组使用9.00 mL 0.125%罗哌卡因+1.00 mL布托啡诺，D组使用8.5 mL 0.125%罗哌卡因+1.5 mL布托啡诺，各47例。主要观察指标包括不同时间节点疼痛程度、镇痛效果、产程、Bromage评分、新生儿Apgar评分、镇痛效果以及并发症情况。结果 各组镇痛前、镇痛后10 min、镇痛后30 min视觉模拟评分法（VAS）比较，结果 ①不同时间点VAS评分比较，差异有统计学意义（P <0.05）；②各组VAS评分比较，差异有统计学意义（P <0.05）；③各组VAS评分变化趋势比较，差异有统计学意义（P <0.05）。各组镇痛起效时间依次缩短（P <0.05），自控镇痛（PCA）按压次数依次减少（P <0.05），首次PCA时间依次延长（P <0.05）。各组第一产程时间依次缩短（P <0.05）。各组第二、三产程时间比较，差异均无统计学意义（P >0.05）。各组镇痛30 min、胎儿分娩时的Bromage评分比较，结果 ①不同时间点Bromage评分比较，差异有统计学意义（P <0.05）；②各组Bromage评分比较，差异无统计学意义（P >0.05）；③各组Bromage评分变化趋势比较，差异无统计学意义（P >0.05）。各组出生后1 min、出生后5 min的Apgar评分比较，结果 ①不同时间点Apgar评分比较，差异无统计学意义（P >0.05）；②各组Apgar评分比较，差异无统计学意义（P >0.05）；③各组Apgar评分变化趋势比较，差异无统计学意义（（P >0.05）。各组不良事件总发生率比较，差异有统计学意义（P <0.05）。结论 9.00 mL 0.125%罗哌卡因+1.00 mL布托啡诺的组合能有效降低产妇疼痛程度，缩短产程，保证分娩镇痛方式的安全有效，值得临床推广。

Abstract:

Objective To investigate the effects of different doses of butorphanol combined with epidural analgesia on stages of labor and analgesic effect in parturients.Methods A total of 188 parturients who gave birth at Changzhou Maternal and Child Health Hospital from October 2022 to October 2023 were selected and divided into four groups using a random number table method. The group A (n = 47) received 9.75 mL of 0.125% ropivacaine plus 0.25 mL of butorphanol, group B (n = 47) received 9.50 mL of 0.125% ropivacaine plus 0.50 mL of butorphanol, group C (n = 47) received 9.00 mL of 0.125% ropivacaine plus 1.00 mL of butorphanol, and group D (n = 47) received 8.50 mL of 0.125% ropivacaine plus 1.50 mL butorphanol. Primary outcomes included pain intensity, analgesic effects, stages of labor, Bromage scores, and neonatal Apgar scores at various time points as well as complications.Results The Visual Analog Scale (VAS) scores before and 10 minutes and 30 minutes after analgesia in all groups were compared via the repeated measures ANOVA, which demonstrated that they were different among the time points (P < 0.05) and the groups (P < 0.05), and that the change trends of the VAS scores were different among the groups (P < 0.05). The onset times of analgesia shortened sequentially (P < 0.05), the number of PCA press reduced sequentially (P < 0.05), and the time of the first PCA prolonged sequentially (P < 0.05) in each group. The duration of the first stage of labor decreased sequentially across the groups (P < 0.05), while no significant difference was observed in the second and the third stages of labor among the groups (P > 0.05). The Bromage scores after 30 minutes of analgesia and at delivery in all groups were compared via the repeated measures ANOVA, exhibiting that they were different among the time points (P < 0.05) but not among the groups (P > 0.05), and that the change trends of Bromage scores were not different among the groups (P > 0.05). The Apgar scores at 1 minute and 5 minutes after birth in all groups were also compared via the repeated measures ANOVA, which showed that they were not different among the time points (P >0.05) or among the groups (P > 0.05), and that the change trends of Apgar scores were not different among the groups (P > 0.05). A significant difference in the incidence of adverse events among the groups was detected via the Chi-square test (P < 0.05).Conclusions The combination of 9.00 mL of 0.125% ropivacaine with 1.00 mL of butorphanol effectively reduces pain intensity, shortens labor duration, and ensures the safety and efficacy of labor analgesia, making it worthy of being widely applied in clinical practice.