布托啡诺复合甲哌卡因经TAP阻滞在剖宫产术后镇痛的临床观察作者：程小融吴巧玲王昊来源：《中国医学创新》2021年第16期【摘要】目的：探讨布托啡诺复合甲哌卡因经腹横肌平面阻滞在剖宫产术后镇痛中的有效性和安全性。

方法：选择2019年1-12月90例拟于单次蛛网膜下腔阻滞下行剖宫产手术的患者，按随机数字表法随机分为对照组（C组）、布托啡诺1组（B1组）、布托啡诺2组（B2组），每组30例。

三组均在手术结束即刻实施超声引导下双侧腹横肌平面阻滞。

C组给予甲哌卡因+右美托咪定;B1组在C组基础上给予4 mg布托啡诺;B2组在C组基础上给予8 mg 布托啡诺。

比较三组术后2、4、8、12、24 h的静息和活动疼痛视觉模拟评分（visual analogue scale，VAS）及Ramsay镇静评分;比较三组术后24 h内补救镇痛、恶心、呕吐发生率、术后镇痛满意度、术后首次下床时间和术后至出院时间。

结果：B1、B2组产妇术后2、4、8、12 h静息和活动VAS评分均低于C组，差异均有统计学意义（P<0.05）;术后24 h，三组产妇静息和活动VAS评分比较，差异均无统计学意义（P>0.05）。

B1、B2组产妇术后2、4、8、12 h Ramsay镇静评分均高于C组，且B2组高于B1组，差异均有统计学意义（P<0.05）;术后24 h 三组产妇Ramsay镇静评分比较，差异均无统计学意义（P>0.05）。

三组产妇术后首次下床时间及术后至出院时间比较，差异均无统計学意义（P>0.05）。

B1、B2组术后补救镇痛率低于C组（P<0.05）;B2组术后恶心、呕吐发生率高于C组、B1组，差异均有统计学意义（P<0.05）;B1组术后镇痛满意度高于C组、B2组，差异均有统计学意义（P<0.05）。

结论：布托啡诺复合甲哌卡因经腹横肌平面阻滞用于剖宫产术后镇痛效果良好，且布托啡诺的合理应用剂量为4 mg。

【关键词】布托啡诺甲哌卡因右美托咪定腹横肌平面阻滞剖宫产Clinical Observation of Analgesic Effect of Butorphanol Combined with Mepivacaine for Transverse Abdominal Plane Block after Cesarean Section/CHENG Xiaorong， WU Qiaoling，WANG Hao. //Medical Innovation of China， 2021， 18（16）： 0-070[Abstract] Objective： To investigate the efficacy and safety of Butorphanol combined with Mepivacaine for transversus abdominal plane block of analgesia after cesarean section. Method： A total of 90 patients underwent caesarean section under single subarachnoid block from January to December were selected， they were divided into control group （group C）， Butorphanol group 1 （group B1） and Butorphanol group 2 （group B2） according to random number table method，30 patients in each group. Group C was given Mepivacaine + Dexmedetomidine; Group B1 was given4 mg Butorphanol in addition to group C; Group B2 was given 8 mg Butorphanol in addition to groupC. Resting and active pain visual analogue scale （VAS） and Ramsay sedation scores at 2， 4，8， 12， and 24 h after surgery were compared among three groups. The incidence of remedial analgesia， nausea and vomiting， total satisfaction with postoperative analgesia were compared among three groups within 24 h after surgery， and the time of first getting out of bed after surgery and postoperative to discharge time were compared among three groups. Result： The resting and active pain VAS scores of groups B1 and B2 at 2， 4， 8 and 12 h after surgery were lower than those of group C， with statistical significance （P<0.05）. At 24 h after surgery， there were no statistical significances in resting and active VAS scores among three groups （P>0.05）. Ramsay sedation scores at 2， 4， 8 and 12 h after surgery of groups B1 and B2 were higher than those of group C， and those of group B2 were higher than those of group B1， the differences were statistically significant （P<0.05）. There were no significant differences in Ramsay sedation scores among three groups 24 h after surgery （P>0.05）. There were no significant differences in the time of first getting out of bed after surgery and the postoperative to discharge time among three groups （P>0.05）. The remedial analgesia rate of groups B1 and B2 were lower than that of group C（P<0.05）. The incidences of postoperative nausea and vomiting of group B2 were higher than those of group C and group B1， with statistical significance （P<0.05）. The total satisfaction of groupB1 was higher than that of group C and group B2， with statistical significance （P<0.05）. Conclusion： The analgesic effect of Butorphanol combined with Mepivacaine for transverse abdominal plane block after cesarean section is fine， and the reasonable dosage of Butorphanol is 4 mg.[Key words] Butorphanol Mepivacaine Dexmedetomidine Transversus abdominal plane block Cesarean sectionFirst-author’s address： The First Affiliated Hospital of Jinzhou Medical University， Jinzhou 121001， Chinadoi：10.3969/j.issn.1674-4985.2021.16.016剖宫产术至今仍然是一些合并骨盆狭窄、头盆不称以及严重妊娠合并症产妇的首选分娩方式，但剖宫产术切口所致的腹壁痛及子宫收缩引起的内脏痛仍是影响患者对术后疼痛管理满意度的重要影响因素。

超声引导下的经腹横肌平面（transversus abdominis plane，TAP）阻滞经过大量的临床实践证实，对于下腹部手术患者的术后镇痛效果较好、加速患者术后康复[1-2]。

布托啡诺是一种脂溶性的阿片受体激动-拮抗剂，对三类阿片受体κ、μ、δ的亲和力为25︰4︰1，对κ受体的高度选择性使其对迷走神经支配的内脏器官具有良好的镇痛作用，即可有效地缓解内脏痛[3]。

Syracuse[4]的一篇关于布托啡诺在人类围生期的分布的文章表明：布托啡诺经产妇乳汁分泌极少，经母乳喂养对新生儿几乎无影响。

甲哌卡因是一种酰胺类局麻药，其起效快、作用较持久、安全用药剂量范围大，可用于硬膜外阻滞和区域神经阻滞[5]。

目前临床多采用PCIA行剖宫产术后镇痛，经静脉用药会增加嗜睡、呼吸抑制等不良反应。

因此，如何实现剖宫产术后镇痛模式的优化、如何在达到有效镇痛的同时降低不良反应发生率，对产妇术后早期恢复及早期哺乳具有重要意义。

目前，尚未见布托啡诺复合局麻药经TAP阻滞用于剖宫产术后镇痛。

本研究的目的在于探讨布托啡诺复合甲哌卡因经TAP阻滞在剖宫产术后镇痛中的有效性及探究布托啡诺的合理用药量，为临床麻醉工作提供参考。

1 资料与方法1.1 一般资料选择2019年1-12月90例在本院行剖宫产术的产妇。