地佐辛静脉镇痛对剖宫产术后母乳喂养RID值的影响和有效性评价  

Evaluation of RID Value and Effectiveness of Dezocine Used for Intravenous Analgesia in Breast-feeding Women after Cesarean Section

作　　者：巩文怡[1] 岳小芳 李士通[3] 徐冰[1] GONG Wenyi;YUE Xiaofang;LI Shitong;XU Bing(Shanghai First People’s Hospital,Baoshan Branch,Shanghai 200940,China;Dong Hospital of Shanghai 6th People’s Hospital,Shanghai 201306,China;Affiliated First People’s Hospital of Shanghai Jiao Tong University,Shanghai 200080,China)

机构地区：[1]上海第一人民医院宝山分院,上海200940 [2]上海第六人民医院东院,上海201306 [3]上海交通大学附属第一人民医院,上海200080

出　　处：《北华大学学报（自然科学版）》2020年第1期70-73,共4页Journal of Beihua University（Natural Science）

基　　金：国家自然科学基金青年科学基金项目(31400953);上海市宝山区科委科技创新专项资金项目(16-E-5)

摘　　要：目的评价地佐辛静脉镇痛对剖宫产术后母乳喂养的安全性、镇痛的有效性、泌乳的影响.方法选择剖宫产足月产妇150例,随机分为3组,自控芬太尼+地佐辛静脉镇痛(PCIA(D))组51例,自控芬太尼+曲马多静脉镇痛(PCIA(T))组50例,硬膜外自控镇痛(PCEA)组49例.评价3组患者术后24,48 h的视觉模拟(VAS)评分,评价患者术后48 h内宫缩痛、不良反应发生率、泌乳情况、新生儿神经和适应能力评分(NACS),测定术后48 h PCIA(D)组产妇乳汁中地佐辛浓度,并计算相对婴儿剂量(RID)值.结果宫缩痛、头晕PCIA(D)组与PCIA(T)组、PCEA组比较差异具有统计学意义(P<0.05);恶心呕吐、嗜睡PCIA(D)组与PCIA(T)组比较差异具有统计学意义(P<0.05).PCIA(D)组48 h母乳中地佐辛浓度为(24.85±20.64)ng/mL (95%CI:0-66.70 ng/mL);RID值为(1.65±1.34)%(95%CI:0-4.70%).结论地佐辛静脉镇痛可安全用于剖宫产术后产妇的镇痛,通过乳汁分泌对新生儿的影响在安全范围内.Objective To evaluate the safety,analgesic efficacy and the effect on lactation of intravenous analgesia with dezocine in breast-feeding women after cesarean. Method 150 full-term parturients undergoing cesarean section were randomly divided into three groups: 51 cases in the patient-controlled intravenous analgesia with fentanyl and dezocine( PCIA( D)) group,50 cases in the patient-controlled intravenous analgesia with fentanyl and tramadol( PCIA( T)) group and 49 cases in the patient-controlled epidural analgesia( PCEA)group. The visual analogue scale( VAS) score 24 hours and 48 hours after operation were recorded. The incidence of uterine contraction pain and adverse reactions,lactation and neonatal NACS scores were evaluated within 48 hours in the three groups. The concentration of dezocine in breast milk was determined 48 hours after operation,and RID values were calculated. Results The difference between uterine contraction pain and dizziness in PCIA( D) with PCIA group and PCEA group have statistic significance( P <0. 05). The difference between nausea and vomiting in PCIA( D) with PCIA group have statistic significance( P < 0. 05). The concentration of dezocine in breast milk of PCIA( D) group was 24. 85 ± 20. 64 ng/m L( 95% CI: 0 $66. 70 ng/m L) and the RID value was( 1. 65 ± 1. 34) %( 95% CI: 0 $4. 70%). Conclusion Intravenous analgesia with dezocine can be safely used for the analgesia of parturients after cesarean section,and the influence of breast milk on newborns is within the safe range.

关 键 词：地佐辛 母乳 药物浓度 相对婴儿剂量 

分 类 号：R614[医药卫生—麻醉学]