不同浓度罗哌卡因复合纳布啡硬膜外阻滞对分娩镇痛的影响  

Effects of different concentrations of ropivacaine combined with epidural block of nalbuphine on laboRanalgesia

作　　者：刘伟[1] 王晓霞[1] LIU Wei;WANG Xiaoxia(Department of Anesthesiology,Ma′anshan City Shiqiye Hospital in Anhui Province,Ma′anshan,Anhui,243000)

机构地区：[1]安徽省马鞍山市十七冶医院麻醉科,安徽马鞍山243000

出　　处：《实用临床医药杂志》2022年第20期131-135,共5页Journal of Clinical Medicine in Practice

基　　金：2019年度安徽省重点研究与开发计划项目(201904j07020)。

摘　　要：目的探讨不同浓度罗哌卡因复合纳布啡硬膜外阻滞对分娩镇痛的影响。方法选取2019年1月—2021年1月分娩的单胎初产妇180例作为研究对象,随机分为Ⅰ组、Ⅱ组和Ⅲ组,每组60例。Ⅰ组采用0.100%罗哌卡因+0.3 mg/mL纳布啡,Ⅱ组采用0.125%罗哌卡因+0.3 mg/mL纳布啡,Ⅲ组采用0.150%罗哌卡因+0.3 mg/mL纳布啡,3组均采用硬膜外间断注射给药。观察3组产妇的给药情况、镇痛起效时间、视觉模拟评分法(VAS)评分、Bromage评分、产程时间、分娩方式、Apgar评分、出血量及不良反应发生情况。结果Ⅲ组产妇镇痛起效时间短于Ⅱ组、Ⅰ组,给药次数少于Ⅱ组、Ⅰ组,给药间隔时间、首次患者自控镇痛(PCA)时间长于Ⅱ组、Ⅰ组,差异有统计学意义(P<0.05)。3组产妇不同时间点VAS评分、Bromage评分、第一产程时间、不良反应发生率及出血量比较,差异无统计学意义(P>0.05)。Ⅲ组产后24 h血清泌乳素水平、新生儿Apgar评分高于Ⅱ组、Ⅰ组,差异有统计学意义(P<0.05)。结论罗哌卡因复合纳布啡用于硬膜外分娩镇痛的安全性良好,可显著减轻产妇分娩疼痛,且不会影响母婴安全。0.150%罗哌卡因复合0.3 mg/mL纳布啡对运动神经阻滞只具有轻微影响,不良反应发生率较低,可作为硬膜外分娩镇痛的一种较为理想的用药方案。Objective To investigate the effects of different concentrations of ropivacaine combined with epidural block of nalbuphine on labor analgesia.Methods A total of 180 singleton primiparas who delivered from January 2019 to January 2021 were selected as the research objects,and were randomly divided into group Ⅰ,group Ⅱ and group Ⅲ,with 60 cases in each group.The group Ⅰ was given 0.100% ropivacaine and 0.3 mg/mL nalbuphine,the group Ⅱ was given0.125% ropivacaine and 0.3 mg/mL nalbuphine,and the group Ⅲ was given 0.150% ropivacaine and 0.3 mg/mL nalbuphine,all groups were given epidural intermittent injection.The drug administration,onset time of analgesia,visual analogue scale(VAS) score,Bromage score,labor time,delivery mode,Apgar score,blood loss and adverse reactions of parturient women in the three groups were observed.Results The onset time of analgesia in the group Ⅱ was significantly shorter than that in the groups Ⅱ and Ⅰ,the frequency of administration was less than that in the groups Ⅱ andⅠ,the interval of administration and the time of first patient-controlled analgesia(PC A) were significantly longer than those in the groups Ⅱ and Ⅰ(P <0.05).There were no significant differences in VAS,Bromage score,time of first stage of labor,incidence of adverse reactions and blood loss among the three groups at different time points(P> 0.05).The serum prolactin level and neonates Apgar score at 24 h after delivery in the group Ⅲ were significantly higher than those in the groups Ⅱ andⅠ(P <0.05).Conclusion The ropivacaine combined with nalbuphine for epidural labor analgesia is safe,which can significantly reduce maternal labor pain and will not affect the safety of mother and child.0.150% ropivacaine combined with 0.3 mg/mL nalbuphine has only slight effect on motor nerve block,and the incidence of adverse reactions is low,which can be used as an ideal drug choice program for epidural labor analgesia.

关 键 词：罗哌卡因 纳布啡 硬膜外阻滞 分娩镇痛 初产妇 

分 类 号：R714[医药卫生—妇产科学] R614[医药卫生—临床医学]