预防性给予纳布啡对急诊剖宫产产妇蛛网膜下腔阻滞联合硬膜外阻滞后寒战的影响  

Effects of prophylactic nalbuphine on shivering after spinal-epidural block in urgent cesarean section

作　　者：刘晶晶 黄绍强 孙申 孙星峰 LIU Jingjing;HUANG Shaoqiang;SUN Shen;SUN Xingfeng(Department of Anaesthesiology,Obstetrics and Gynecology Hospital of Fudan University,Shanghai 200090,China)

机构地区：[1]复旦大学附属妇产科医院麻醉科,上海200090

出　　处：《上海医学》2020年第10期587-594,共8页Shanghai Medical Journal

摘　　要：目的探讨预防性给予纳布啡对急诊剖宫产产妇蛛网膜下腔阻滞联合硬膜外阻滞后寒战的临床效果。方法选择复旦大学附属妇产科医院2017年8月—2019年2月间拟行蛛网膜下腔阻滞联合硬膜外阻滞麻醉、已进入产程需行急诊剖宫产术的产妇60例,采用随机数字表法分为对照组、纳布啡低剂量组和纳布啡高剂量组,每组20例。3组产妇分别于开放静脉后即刻静脉注射0.9%氯化钠溶液4 mL、纳布啡0.08 mg/kg和纳布啡0.12 mg/kg。记录产妇麻醉和手术情况。分别于入手术室给药前(T 0)和麻醉后即刻(T 1)、5 min(T 2)、15 min(T 3)、30 min(T 4)、45 min(T 5)、60 min(T 6)、120 min(T 7)时,测量并记录产妇的平均动脉压(MAP)、心率、经皮动脉血氧饱和度(S pO 2)、耳蜗温度,以及警觉/镇静(OAA/S)评分。记录注药至胎儿娩出和注药至麻醉后30、60、120 min时产妇的寒战发生率、≥3级寒战发生率。观察术中不良反应,记录新生儿出生后1、5 min Apgar评分和脐动脉血血气分析指标[pH值、剩余碱(BE)]。结果纳布啡高剂量组阻滞平面位于胸1至胸2的产妇显著多于对照组和纳布啡低剂量组(P值均<0.05),对照组与纳布啡低剂量组间的差异无统计学意义(P>0.05)。除纳布啡低剂量组T 5时间点的耳蜗温度显著高于对照组同时间点(P<0.01)外,3组间其余各时间点耳蜗温度的差异均无统计学意义(P值均>0.05)。纳布啡低剂量组和纳布啡高剂量组注药至胎儿娩出、注药至麻醉后30 min,以及纳布啡高剂量组注药至麻醉后60、120 min时的寒战发生率均显著低于对照组和纳布啡低剂量组同时间点(P值均<0.01)。纳布啡高剂量组注药至胎儿娩出,以及纳布啡低剂量组和纳布啡高剂量组注药至麻醉后30、60、120 min时的≥3级寒战发生率均显著低于对照组同时间点(P值分别<0.01、0.05);纳布啡高剂量组注药至麻醉后120 min时的≥3级寒战发生率显著低于纳布Objective To explore the clinical efficacy of prophylactic nalbuphine on the shivering after spinal-epidural block in urgent cesarean section.Methods A total of 60 parturients scheduled for urgent cesarean section under combined spinal-epidural block between August 2017 and February 2019 were randomly divided into three groups(n=20):control group,low-dose nalbuphine group and high-dose nalbuphine group.Immediately after intravenous catheterization,normal saline 4 mL,nalbuphine 0.08 mg/kg and nalbuphine 0.12 mg/kg were intravenously injected in the three groups respectively.The parturients’anesthesia and operation were recorded.The mean arterial pressure(MAP),heart rate(HR),pulse oxygen saturation(S pO 2),cochlear temperature and observer assessment of alertness/sedation(OAA/S)scale were recorded before drug administration(T 0),immediately after anesthesia(T 1)and at 5(T 2),15(T 3),30(T 4),45(T 5),60(T 6)and 120 min(T 7)thereafter.The incidence of total shivering and shivering≥grade 3 were recorded during the period from intrathecal injection to fetal delivery and within 30,60 and 120 min after block.Intraoperative adverse reactions were observed.Neonatal Apgar scores were recorded at 1 and 5 min after delivery.The pH and base excess(BE)determined by umbilical artery blood gas analysis were also recorded.Results The composition of parturients with the peak sensory level at thoracic vertebra 1-2 was significantly higher in the high-dose nalbuphine group than those in the other two groups(both P<0.05),but there was no significant difference between the control group and low-dose nalbuphine group(P>0.05).Though the cochlear temperature at T 5 in the low-dose nalbuphine group was significantly higher than that in the control group(P<0.01),there was no significant difference in the cochlear temperature at any other time point among the three groups(all P>0.05).The incidence of shivering during the period from intrathecal injection to fetal delivery and within 30 min after block was significantly lower in the nalbup

关 键 词：纳布啡 寒战 剖宫产术 

分 类 号：R614[医药卫生—麻醉学]