纳布啡患者自控静脉镇痛与程控硬膜外间歇脉冲注入给药方式对分娩镇痛的影响  

Effect of Nalbuphine Administration on Analgesia in Labour:Patient-Controlled Intravenous Analgesia Versus Programmed Intermittent Epidural Bolus

作　　者：杨晓宇 殷国平[1] 王佳[1] 陈慧 YANG Xiaoyu;YIN Guoping;WANG Jia;CHEN Hui(Dept.of Anesthesiology,Nanjing the Second Hospital,Nanjing 210000,China)

机构地区：[1]南京市第二医院麻醉科,南京210000

出　　处：《中国医院用药评价与分析》2022年第9期1089-1092,共4页Evaluation and Analysis of Drug-use in Hospitals of China

基　　金：江苏省优势学科建设工程项目(No.YSHL0815-33)。

摘　　要：目的:对比纳布啡患者自控静脉镇痛(PCIA)与程控硬膜外间歇脉冲注入(PIEB)给药方式对分娩镇痛的影响。方法:选取2020年11月至2021年8月该院收治的68例足月、单胎、头位孕产妇,根据镇痛方法不同分为PCIA组、PIEB组,各34例。比较两组患者入临产室时、宫口开至2 cm时、宫口开至3 cm时、宫口开至4 cm时、宫口全开时和胎儿娩出时的疼痛视觉模拟评分(VAS)、心率(HR)和平均动脉压(MAP),比较两组患者镇痛泵药液用量、产程持续时间,比较两组新生儿Apgar评分、新生儿行为神经测定(NBNA)评分,以及两组患者不良反应发生情况。结果:两组患者入临产室时、宫口开至2 cm时、宫口开至3 cm时、宫口开至4 cm时、宫口全开时和胎儿娩出时的VAS评分比较,差异均无统计学意义(P>0.05)。两组患者不同时刻HR、MAP水平的组间、时点间以及组间·时点间比较,差异均无统计学意义(P>0.05)。PIEB组患者镇痛泵药液用量低于PCIA组,第二产程持续时间短于PCIA组,差异均有统计学意义(P<0.05);两组患者第一产程、第三产程持续时间比较,差异均无统计学意义(P>0.05)。两组新生儿1 min Apgar评分、5 min Apgar评分和24 h NBNA评分比较,差异均无统计学意义(P>0.05)。PIEB组患者尿潴留发生率低于PCIA组,差异有统计学意义(P<0.05)。结论:纳布啡PIEB给药用于分娩镇痛可获得与PCIA相似的镇痛效果和血流动力学稳定效果,在不影响孕产妇和新生儿状况的前提下,减少了镇痛泵药液用量和尿潴留发生,缩短了第二产程持续时间,具有临床应用优势。OBJECTIVE: To compare the effects of patient-controlled intravenous analgesia(PCIA) versus programmed intermittent epidural bolus(PIEB) administration in nalbuphine patients on labour analgesia.METHODS: A total of 68 full-term, singleton, and cephalic pregnant women admitted into the hospital from Nov. 2020 to Aug. 2021 were extracted to be divided into the PCIA group and PIEB group according to different analgesic method, with 34 cases in each group. The visual analogue score of pain(VAS), heart rate(HR) and mean arterial pressure(MAP) at the time of admission to the delivery room, at 2 cm opening, at 3 cm opening, at 4 cm opening, at full opening and at the time of delivery were compared between two groups. The dosage of analgesic pump liquid and the duration of labor were compared between two groups. The neonatal Apgar score, neonatal behavioral neurological assessment(NBNA) score, and the incidence of adverse drug reactions were compared between two groups. RESULTS: There was no statistically significant difference between two groups in the VAS scores at the time of admission to the delivery room, at 2 cm opening, at 3 cm opening, at 4 cm opening, at full opening and at the time of delivery(P>0.05). There was no statistically significant difference between groups, between time points and between groups·time points in the comparison of HR and MAP levels at different moments in both groups(P>0.05). The dosage of analgesic pump in the PIEB group was lower than that in PCIA group, and the duration of the second stage of labor was shorter than that in PCIA group, the differences were statistically significant(P<0.05). There was no significant difference in the duration of the first stage of labor and the third stage of labor between two groups(P>0.05). There was no statistically significant difference in the 1 min Apgar score, 5 min Apgar score and 24 h NBNA score between two groups of neonates(P>0.05). The incidence of urinary retention in the PIEB group was lower than that in PCIA group, with statistically sign

关 键 词：纳布啡 分娩镇痛 患者自控静脉镇痛 程控硬膜外间歇脉冲注入 

分 类 号：R971.2[医药卫生—药品]