布托啡诺不同给药途径治疗剖宫产术中寒战的临床对比观察(1)
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[摘要] 目的 对比布托啡诺不同给药途径在治疗剖宫产手术中寒战的临床效果及安全性。 方法 选择椎管内麻醉下择期行剖宫产手术产妇60例，ASA Ⅰ～Ⅱ级，随机分成三组(n = 20)。Z组：布托啡诺椎管组；J组：布托啡诺静脉组；D组：对照组。观察记录局麻药感觉阻滞起效时间；胎儿娩出前5 min(T1)、胎儿娩出后5 min(T2)、胎儿娩出后10 min(T3)、胎儿娩出后30 min(T4)产妇寒战发生率；T2、T3、T4产妇镇静满意率；术中不良反应；胎儿Apgar评分等。 结果 Z组局麻药起效时间快，T1寒战发生率明显低于J组和D组(P < 0.01)；Z组和J组T2、T3、T4寒战发生率、镇静效果满意率无明显差异(P > 0.05)，与D组有明显差异(P < 0.01)；Z组和J组无不良反应发生；三组胎儿Apgar评分无差异。结论 布托啡诺椎管内给药不仅缩短局麻药起效时间，而且全程有效治疗产妇手术中的寒战；镇静效果满意，不良反应小，安全性较高，无局限性，优于静脉给药。
[关键词] 布托啡诺；寒战；剖宫产
[中图分类号] R614.42 [文献标识码] B [文章编号] 1673—9701(2012)27—0089—03
Clinical observation and comparison of different dosing methods of butorphanol in curing shiver during cesarean
WANG Danyi SHENG Chuanhong
Department of Anesthesiology，the Third People's Hospital of Jingzhou City in Hubei Province，Jingzhou 434000，China
[Abstract] Objective To compare the clinical effect and safety about Butorphanol 's different dosing methods in the treatment of cesarean shiver. Methods Sixty puerperae(ASA level Ⅰ—Ⅱ) who chosed the spinal canal anesthesia and selected cesarean operation were observed randomLy devided into 3 groups(n = 20)：group Z，dosing through spinal canal；gourp J：dosing through vein；group D，the control group. The following data are observed and noted down：1.The time when the local anesthetics takes effect；2.Maternal shivers rate between 5 minutes before childbirth(T1)，5 minutes after birth(T2)，10 minutes after birth(T3) and 30 minutes after birth(T4)；3.T2，T3，and T4 puerpera calm satisfaction rate；4.Adverse reaction during operation；5.Fetal Apgar score，etc. Results Local anesthetics(Group Z) works faster than the other two groups，significantly lower shiver incidence during T1 than J group and D group(P < 0.01)；group Z and Group J had no obvious difference in cesarean shiver incidence and calm effect satisfaction rate(P > 0.05) during T2，T3，T4， However Group D was different(P < 0.01) Z group and J group had no adverse reaction； three groups have same APGAR scores. Conclusion Taking effect much faster，dosing through spinal canal is an efficient therapy for cesarean shiver during the whole operation. It leads to higher satisfaction rate，high security，no limitation and surpasses the Intravenous injection method.
[Key words] Butorphanol；Shiver；Cesarean
寒战是椎管内麻醉常见并发症。剖宫产产妇寒战发生率可高达57%[1]。寒战使产妇产生不适的感觉，使机体耗氧量增加，甚至会影响患者心理和生理，对产妇及胎儿造成更加不利的影响。因此预防或治疗麻醉期的寒战十分必要。布托啡诺静脉注射治疗麻醉后寒战，其效果确切，镇静满意，且不良反应小，但用药时机均需选择在胎儿出生后使用[2]，有一定的局限性。本研究旨在对比观察布托啡诺椎管内给药全程治疗产妇术中寒战的临床效果及安全性。
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