舒芬太尼复合纳布啡用于剖宫产术后患者自控皮下镇痛安全性及有效性的临床研究  

The safety and effectiveness of sufentanil combined with nalbuphine for subcutaneous analgesia after cesarean section: a clinical study

作　　者：卢睿 张茂荷 杨正艳 Lu Rui;Zhang Maohe;Yang Zhengyan(Department of Anesthesiology,Taizhou Hospital of Zhejiang Province,Enze Hospital,Taizhou Enze Medical Center(Group),Taizhou 318000,China;School of Clinical Medicine,Dali University,Dali 671000,China;Department of Anesthesiology,the First Affiliated Hospital of Dali University,Dali 671000,China;Forensic Center of Public Security of Dali,Dali 671000,China)

机构地区：[1]浙江省台州医院,台州恩泽医疗中心(集团)恩泽医院麻醉科,台州318000 [2]大理大学临床医学院,大理671000 [3]大理大学第一附属医院麻醉科,大理671000 [4]大理州公安司法鉴定中心,大理671000

出　　处：《国际麻醉学与复苏杂志》2022年第6期607-610,共4页International Journal of Anesthesiology and Resuscitation

基　　金：云南省科技厅科技计划项目(2019FH001(-028))。

摘　　要：目的:探讨舒芬太尼、纳布啡单一及复合应用于剖宫产术后患者自控皮下镇痛(patient controlled subcutaneous analgesia, PCSA)的安全性及有效性。方法:选取2020年6月—2021年1月行急诊剖宫产术的产妇90例,按随机数字表法分为纳布啡组(N组)、舒芬太尼组(S组)和舒芬太尼+纳布啡组(NS组),每组30例。手术结束前30 min连接镇痛泵。药物配比:N组为纳布啡2 mg/kg+托烷司琼0.1 mg/kg ,S组为舒芬太尼2 μg/kg+托烷司琼0.1 mg/kg,NS组为舒芬太尼1 μg/kg+纳布啡1 mg/kg+托烷司琼0.1 mg/kg。记录3组产妇术后6、12、24 h切口痛和宫缩痛VAS评分,术后24 h Ramsay镇静评分,术后24 h内PCSA按压次数,术后24 h内初乳分泌情况,不良反应发生情况及镇痛满意率;检测N组产妇镇痛期间母乳中纳布啡浓度。结果:3组产妇各时点切口痛VAS评分、术后24 h Ramsay镇静评分、术后24 h内初乳分泌情况、不良反应发生情况比较,差异无统计学意义( P>0.05);NS组产妇各时点宫缩痛VAS评分低于N组、S组( P<0.05),镇痛满意率高于S组( P< 0.05),术后24 h内PCSA按压次数少于N组、S组( P<0.05);N组和S组产妇各时点宫缩痛VAS评分、镇痛满意率、术后24 h内PCSA按压次数比较,差异无统计学意义( P>0.05)。N组共5例产妇镇痛期间取到足量母乳,母乳中均未检测出纳布啡。 结论:纳布啡和舒芬太尼联合使用能减轻剖宫产术后宫缩痛,且不增加不良反应的发生。Objective To explore the safety and effectiveness of sufentanil,nalbuphine and their combined use on patient controlled subcutaneous analgesia(PCSA)after cesarean section.Methods A total of 90 women who underwent emergency cesarean section from June 2020 to January 2021 were selected.According to the random number table method,they were divided into three groups(n=3):a nalbuphine group(group N),a sufentanil group(group S),and a sufentanil+nalbuphine group(group NS).The analgesic pump was connected 30 min before the end of operation.Drug formulation:nalbuphine 2 mg/kg+tropisetron 0.1 mg/kg in group N;sufentanil 2µg/kg+tropisetron 0.1 mg/kg in group S;and sufentanil 1µg/kg+nalbuphine 1 mg/kg+tropisetron 0.1 mg/kg in group NS.The Visual Analogue Scale(VAS)scores of incision pain and uterine contraction pain 6,12 h and 24 h after operation,Ramsay sedation score 24 h after operation,PCSA pressing times within 24 h after operation,colostrum secretion within 24 h after operation,adverse reactions and patient satisfaction rate were recorded.The concentration of nalbuphine in breast milk during analgesia in group N was detected.Results There were no statistical differences in VAS incision pain scores 6,12 h and 24 h after operation,Ramsay sedation scores 24 h after operation,colostrum secretion within 24 h after operation and the incidence of adverse reactions among the three groups(P>0.05).Group NA showed lower VAS scores at uterine contraction than group N and group S at each time point(P<0.05),a higher patient satisfaction rate than group S(P<0.05),and less PCSA pressing times than group N and group S(P<0.05).However,there was no statistical difference in VAS score at uterine contraction,patient satisfaction rate,and PCSA pressing times within 24 h after operation between group N and group S(P>0.05).A total of five parturients in group N secreted sufficient breast milk during analgesia,while no nalbuphine was detected in breast milk.Conclusions The combined use of nalbuphine and sufentanil can effectively relieve ute

关 键 词：纳布啡 舒芬太尼 患者自控皮下镇痛 剖宫产 

分 类 号：R614[医药卫生—麻醉学]