不同浓度纳布啡复合罗哌卡因硬膜外分娩镇痛观察  

Effects of different concentrations of nalbuphine combined with ropivacaine on epidural labor analgesia

作　　者：孙淑芳 邵晓青[1] 孙东娃 黄科昌[3] SUN Shufang;SHAO Xiaoqing;SUN Dongwa;HUANG Kechang(Department of Anesthesiology,Weifang Maternal and Child Health Hospital,Weifang 261021,China;Department of Delivery Room,Weifang Maternal and Child Health Hospital;Department of Pain Medicine,the Affiliated Hospital of Weifang Medical University)

机构地区：[1]潍坊市妇幼保健院麻醉科,山东潍坊261021 [2]潍坊市妇幼保健院产房 [3]潍坊医学院附属医院疼痛科

出　　处：《潍坊医学院学报》2022年第2期139-141,共3页Acta Academiae Medicinae Weifang

摘　　要：目的观察不同浓度纳布啡联合罗哌卡因对硬膜外自镇痛分娩镇痛效果的影响,探讨合适的浓度。方法头胎产妇280例随机分为A、B、C和D组,分别用纳布啡0.1,0.2,0.3和0.4mg/ml复合0.1%罗哌卡因,每组70例。硬膜外置管后脉冲泵行患者自镇痛。主要观察指标为疼痛VAS,次要指标为产程时间、镇痛前、镇痛后5,10,20,30和60min(T_(0)~T_(5))MAP、Ramsay镇静评分、改良Bromage评分,新生儿Apgar评分和血气分析,产妇不良反应和转剖宫产率。结果T_(1)时VAS明显下降(P<0.05);B组在T_(3)、T_(4)时明显低于A组(P<0.05);T_(2)~T_(5)时C组、D组明显低于A、B组(P<0.05)。各产程时长及不良反应均无明显差异。MAP在T_(0)~T_(5)时无明显差异,但T_(3)时明显降低(P<0.05)。与T_(0)比,Ramsay评分各组T_(1)、T_(2)时明显升高(P<0.05),在T_(3)~T_(5)时C、D组高于A、B组(P<0.05);产妇在T_(0)~T_(2)时Ramsay评分、剖宫产率、新生儿Apgar评分和血气均无明显统计学差异。结论0.1~0.3mg/ml纳布啡复合0.1%罗哌卡因用于硬膜外分娩镇痛安全有效,其中0.3mg/ml纳布啡更加合适。Objective To observe the effects of different concentrations of nalbuphine combined with ropivacaine on the analgesic effect of epidural self-induced analgesia in labor,and to explore the appropriate concentration.Methods Two hundred and eighty primiparas were randomly divided into groups A,B,C and D.Nalbuphine 0.1,0.2,0.3 and 0.4mg/ml combined with 0.1%ropivacaine were used in 70 cases in each group.Self analgesia with pulse pump was performed after epidural catheterization.The main index of observation was pain VAS,and the secondary index of observation were labor process time,MAP before analgesia,5,10,20,30 and 60min after analgesia(T_(0)~T_(5)),Ramsay Sedation score,modified Bromage score,neonatal Apgar score and blood gas analysis,maternal adverse reactions and rate of conversion to cesarean delivery.Results The VAS scores decreased significantly at T_(1)(P<0.05).Group B was significantly lower than group A at T_(3) and T_(4)(P<0.05).From T_(2) to T_(5),group C and group D were significantly lower than group A and group B(P<0.05).There was no significant difference in the duration of labor and adverse reactions.Map had no significant difference between T_(0) and T_(5),but decreased significantly at T_(3)(P<0.05).Compared with T_(0),Ramsay score in each group increased significantly at T_(1) and T_(2)(P<0.05),and group C and D were higher than those in group A and B at T_(3)~T_(5)(P<0.05).There was no significant difference in Ramsay score,cesarean section rate,neonatal Apgar score and blood gas between T_(0) and T_(2).Conclusion 0.1~0.3mg/ml nalbuphine combined with 0.1%ropivacaine is safe and effective for epidural labor analgesia,of which 0.3mg/ml nalbuphine is more appropriate.

关 键 词：纳布啡 酰胺类 镇痛 产科 镇痛 硬膜外 

分 类 号：R714.3[医药卫生—妇产科学]