纳布啡或舒芬太尼复合罗哌卡因在分娩镇痛中PCEA 的适宜配伍  

Appropriate dosage of nalbuphine or sufentanil combined with ropivacaine in patient-controlled epidural analgesia during labor

作　　者：杨恒[1] 张地宝[1] 张云云[1] 任三姐[1] 骆宏[1] 李蕾[1] YANG Heng;ZHANG Dibao;ZHANG Yunyun;REN Sanjie;LUO Hong;LI Lei(Department of Anesthesiology,Hefei No.1 People′s Hospital(Hefei Binhu Hospital),Hefei 230091,China)

机构地区：[1]合肥市第一人民医院南区合肥市滨湖医院麻醉科,安徽合肥230091

出　　处：《皖南医学院学报》2021年第5期471-474,共4页Journal of Wannan Medical College

基　　金：合肥市卫计委应用医学研究资助项目(hwk2018zc016)。

摘　　要：目的:评价纳布啡或舒芬太尼复合罗哌卡因在分娩镇痛中PCEA的适宜配伍。方法:选择合肥市滨湖医院单胎、足月妊娠初产妇125例,采用随机数字表法将孕产妇分为5组,每组25例。舒芬太尼0.5μg/mL+0.1%罗哌卡因(S组)、纳布啡0.2 mg/mL+0.1%罗哌卡因(N1组)、纳布啡0.3 mg/mL+0.1%罗哌卡因(N2组)、纳布啡0.4 mg/mL+0.1%罗哌卡因(N3组)、舒芬太尼0.25μg/mL+纳布啡0.2 mg/mL+0.1%罗哌卡因(NS组)。观察分娩镇痛前,第一、二产程的VAS、Ramsay评分;PCEA按压次数,改良Bromage评分;新生儿出生后1、5 min的Apgar评分;产前及产后3天抑郁量表评分;分娩镇痛期间的不良反应。结果:与分娩镇痛前比较,5组第一、二产程VAS评分均降低(P<0.05);与N1组比较,S组、N2组N3组、NS组第一、二产程VAS评分降低(P<0.05)。与S组、N1组比较,N2组、N3组、NS组Ramsay评分升高(P<0.05)。与N1组、S组比较,N2组、N3组、NS组PCEA按压次数减少(P<0.05)。与S组、N1组比较,N3、NS组产后3天抑郁量表评分降低(P<0.05);与N2组比较,NS组产后3天抑郁量表评分降低(P<0.05)。与S组比较,N1、N2、N3、NS组4组恶心呕吐及皮肤瘙痒发生率降低(P<0.05)。结论:0.2 mg/mL纳布啡+0.25μg/mL舒芬太尼复合0.1%罗哌卡因分娩镇痛效果明确、不良反应低,为分娩镇痛PCEA的适宜配伍。Objective:To evaluate the appropriate dosage of nalbuphine or sufentanil combined with ropivacaine in patient-controlled epidural analgesia(PCEA)during labor.Methods:125 primiparous women of singleton and full-term pregnancy were included in our hospital,and divided into 5 groups by random number table method(n=25 in each group).S group(sufentanil 0.5μg/mL plus 0.1%ropivacaine),N1 group(nalbuphine 0.2 mg/mL plus 0.1%ropivacaine),N2 group(nalbuphine 0.3 mg/mL plus 0.1%ropivacaine),N3 group(nalbuphine 0.4 mg/mL plus 0.1%ropivacaine),and NS group(sufentanil 0.25μg/mL+nalbuphine 0.2 mg/mL+0.1%ropivacaine).All women were observed concerning the scoring on visual analog scale(VAS)and Ramsay scores before labor analgesia,at the first and the second stage of labor,frequencies of PCEA use,modified Bromage score,Apgar score of the newborn at 1 and 5 min after birth,scoring on the depression scale before delivery and 3 days after delivery,and adverse reactions during labor analgesia.Results:VAS scores in the first and the second stage of labor in the five groups were significantly reduced compared to the scoring before labor analgesia(P<0.05).Scoring on VAS was markedly declined at the first and the second stage of labor in women in S,N2,N3 and NS group compared to those in N1 group(P<0.05).Ramsay scores were significantly higher,and the frequencies of PCEA use were lower in N2,N3 and NS group than in S group and N1 group(all P<0.05).Women in N3 and NS group had significantly lower scoring on the depression scale at day 3 after delivery than those in S group and N1 group(P<0.05),and the scores on depression scale were evidently lower in women in NS group than those in N2 group at day 3 after delivery(P<0.05).Women in N1,N2,N3 and NS group had lower incidence of nausea,vomiting and skin pruritus than those in S group(P<0.05).Conclusion:0.2 mg/mL nalbuphine plus 0.25μg/mL sufentanil combined with 0.1%ropivacaine can lead to better analgesic effect during labor,yet produce lower side effects,suggesting that this dosage shou

关 键 词：纳布啡 舒芬太尼 罗哌卡因 分娩镇痛 硬膜外麻醉 

分 类 号：R714.1[医药卫生—妇产科学] R614.4[医药卫生—临床医学]