布托啡诺与盐酸纳布啡对腰硬联合麻醉剖宫产产妇血流动力学及寒战发生的影响

Effects of butorphanol versus nalbuphine hydrochloride on hemodynamics and shivering in parturients undergoing cesarean section with combined spinal-epidural anesthesia

摘要:

目的 探讨术中应用布托啡诺与盐酸纳布啡对接受腰硬联合麻醉的剖宫产产妇在胎儿取出后的血流动力学及寒战发生的影响。方法 选取2024年4月—2024年10月阜阳市人民医院82例拟行剖宫产的产妇为研究对象，随机分为布托啡诺组与盐酸纳布啡组，每组41例。分别在胎儿取出后用药前（T₁）、用药后5 min（T₂）、子宫缝合结束时（T₃）及术毕（T₄）测量两组产妇的平均动脉压（MAP）、心率（HR）、血氧饱和度（SpO₂），评估不同时间点的Ramsey镇静评分，观察和记录围麻醉期寒战发生情况及不良反应。结果 布托啡诺组与盐酸纳布啡组在T₁、T₂、T₃及T₄时的MAP、HR、SpO₂比较，结果 ①不同时间点MAP、HR、SpO₂比较，差异均有统计学意义（P <0.05）；②布托啡诺组与盐酸纳布啡组MAP、HR、SpO₂比较，差异均有统计学意义（P <0.05），布托啡诺组MAP、HR较盐酸纳布啡组低，SpO₂较盐酸纳布啡组高；③布托啡诺组与盐酸纳布啡组MAP、HR、SpO₂变化趋势比较，差异均无统计学意义（P >0.05）。布托啡诺组与盐酸纳布啡组在T₁、T₂、T₃及T₄时的Ramsey镇静评分比较，结果 ①不同时间点Ramsey镇静评分比较，差异有统计学意义（P <0.05）；②布托啡诺组与盐酸纳布啡组Ramsey镇静评分比较，差异有统计学意义（P <0.05），布托啡诺组Ramsey镇静评分较盐酸纳布啡组高；③布托啡诺组与盐酸纳布啡组Ramsey镇静评分变化趋势比较，差异无统计学意义（P >0.05）。盐酸纳布啡组围麻醉期寒战发生率高于布托啡诺组（P <0.05）。布托啡诺组与盐酸纳布啡组不良反应发生率比较，差异无统计学意义（P >0.05）。结论 布托啡诺相较于盐酸纳布啡，在腰硬联合麻醉的剖宫产中能够更有效地稳定产妇的血流动力学，降低寒战发生率，且具有较好的镇静效果和安全性，提示其在麻醉中的应用有效性。

Abstract:

Objective To compare the effects of intraoperative butorphanol and nalbuphine hydrochloride on hemodynamics and shivering in parturients receiving combined spinal-epidural anesthesia (CSEA) during cesarean section after fetal delivery.Methods Eighty-two parturients scheduled for cesarean section at Fuyang People's Hospital from April 2024 to October 2024 were enrolled and randomly divided into a butorphanol group (n = 41) and a nalbuphine group (n = 41). Mean arterial pressure (MAP), heart rate (HR), and oxygen saturation (SpO?) were measured at four time points: pre-medication after fetal delivery (T₁), 5 minutes post-medication (T₂), uterine suture completion (T₃), and surgery conclusion (T₄). Ramsey Sedation Scores were assessed, and peri-anesthetic shivering incidence and adverse reactions were recorded.Results Hemodynamic parameters (MAP, HR, SpO?): (1) Significant temporal variations were observed in both groups (P < 0.05); (2) Intergroup comparisons showed lower MAP, HR and higher SpO? in the butorphanol group versus the nalbuphine group (P < 0.05); (3) No significant differences in parameter trends between groups (P > 0.05). Ramsey Sedation Scores: (1) Scores varied significantly across time points (P < 0.05); (2) Butorphanol group exhibited higher scores than the nalbuphine group (P < 0.05); (3) No intergroup difference in score trends (P > 0.05). The nalbuphine group demonstrated higher peri-anesthetic shivering incidence (P < 0.05), with no intergroup difference in adverse reactions (P > 0.05).Conclusion Compared to nalbuphine, butorphanol administration during CSEA for cesarean section provides superior hemodynamic stability, reduced shivering incidence, and enhanced sedation efficacy without compromising safety.