硬膜外分娩镇痛前静脉注射纳布啡用于抑制初产妇宫缩疼痛的价值  

Evaluation of efficacy of intravenous nalbuphine before epidural labor analgesia in inhibiting uterine contraction pain in primiparae

作　　者：谢雷 史景发 张蓉 方向东 Xie Lei;Shi Jingfa;Zhang Rong;Fang Xiangdong(Department of Anesthesiology,Anhui Province Maternity&Child Health Hospital,Hefei 230001,China)

机构地区：[1]安徽省妇幼保健院麻醉科,合肥230001

出　　处：《中华麻醉学杂志》2022年第9期1086-1088,共3页Chinese Journal of Anesthesiology

摘　　要：目的评价硬膜外分娩镇痛前静脉注射纳布啡用于抑制初产妇宫缩疼痛的价值。方法选择适宜且自愿行硬膜外分娩镇痛的单胎头位初产妇140例,年龄20~40岁,ASA分级Ⅰ或Ⅱ级,宫颈口扩张2~3 cm。胎儿未见异常,采用随机数字表法分为2组(n=70):纳布啡组(N组)和常规组(C组),在硬膜外腔穿刺术前10 min N组静脉注射0.1 mg/kg纳布啡(生理盐水稀释至5 ml),C组静脉注射生理盐水5 ml。记录硬膜外穿刺术相关项目:宫缩时疼痛程度(NRS评分)和镇静-躁动程度(Riker评分),穿刺术时间、孕产妇满意度、一次性穿刺成功及并发症发生情况。结果与C组相比,N组硬膜外穿刺术中宫缩痛NRS评分和Riker评分降低(P<0.05),且NRS评分均<6分、Riker评分均为4分,硬膜外穿刺术时间缩短,一次性穿刺成功率升高,神经异感及误入血管发生率降低,孕产妇满意度升高(P<0.05)。结论硬膜外分娩镇痛前静脉注射纳布啡0.1 mg/kg可安全、有效地降低初产妇宫缩疼痛且肢体无燥动,有助于硬膜外穿刺术的顺利实施。Objective To assess the value of nalbuphine intravenously injected before epidural labor analgesia in inhibiting uterine contraction pain in primiparae.Methods A total of 140 expectant primiparae who were suitable and willing to receive epidural labor analgesia with a singleton fetus in vertex presentation,aged 20-40 yr,of American Society of Anesthesiologists Physical Status classificationⅠ-Ⅱ,with their cervical dilation of 2-3 cm,were divided into nalbuphine group(N group)and routine control group(C group),with 70 cases in each group.Group N received intravenous injection of nalbuphine 0.1 mg/kg(in normal saline 5 ml)at 10 min before epidural puncture,while group C received intravenous injection of the equal volume of normal saline at 10 min before epidural puncture.The epidural puncture-related items including the intensity of pain(Numeric Rating Scale[NRS]scores)and degree of sedation-agitation(Riker sedation agitation scores)during uterine contraction,duration of epidural procedure,parturients′satisfaction with epidural puncture,successful epidural catheterization at first attempt and complications(nerve paraesthesia and inadvertent intravascular punctures)were recorded.Results Compared with group C,the NRS scores and Riker scores for uterine contraction pain were significantly decreased during epidural procedure(P<0.05),with NRS score<6 and Riker sedation agitation scores of 4,the duration of epidural puncture was shortened,the success rate of epidural puncture at first attempt was increased(51%/70%),and the incidence of nerve paraesthesia and inadvertent intravascular puncture was decreased(17%/6%,14%/4%),and the parturients′satisfaction with epidural puncture was increased in group N(P<0.05).Conclusions Nalbuphine 0.1 mg/kg intravenously injected before epidural labor analgesia can safely and effectively reduce uterine contraction pain without limb agitation,which is helpful in implementating epidural puncture in primiparae.

关 键 词：纳布啡 脊椎穿刺 分娩疼痛 镇痛 产科 镇痛 硬膜外 

分 类 号：R714.3[医药卫生—妇产科学]