硬膜外纳布啡复合罗哌卡因对剖宫产术后镇痛效果和睡眠质量的影响  

Effects of epidural ropivacaine alone or combined with nalbuphine on analgesia and sleep quality in patients after cesarean section

作　　者：张晓娟 马卫兰 马汉祥[2] ZHANG Xiaojuan;MA Weilan;MA Hanxiang(Department of Anesthesiology,Wuzhong People’s Hospital,Wuzhong 751100,China;Department of Anesthesiology,General Hospital of Ningxia Medical University,Yinchuan 750004,China)

机构地区：[1]宁夏吴忠市人民医院麻醉科,宁夏吴忠751100 [2]宁夏医科大学总医院麻醉科,宁夏银川750004

出　　处：《宁夏医学杂志》2023年第9期779-782,共4页Ningxia Medical Journal

基　　金：宁夏重点研发计划项目(2021BEG03048)。

摘　　要：目的探讨硬膜外应用纳布啡复合罗哌卡因对剖宫产术后镇痛效果和睡眠质量的影响。方法选取拟在椎管内麻醉下行剖宫产手术的患者60例,ASAⅡ~Ⅲ级,年龄20~40岁,体重指数BMI≤30,随机分为R组(n=30,硬膜外0.15%罗哌卡因镇痛)、NR组(n=30,硬膜外0.3 mg/mL纳布啡+0.15%罗哌卡因镇痛),记录两组患者术前1 d、术后1 d、术后2 d、术后3 d匹兹堡睡眠质量指数量表评分、阿森斯失眠量表评分。记录2组患者术后4 h、12 h、24 h、48 h切口疼痛、宫缩痛、Bromage评分,记录2组患者术后自控镇痛泵按压次数及术后镇痛并发症的发生情况。结果与R组比较,NR组术后12 h、24 h切口疼痛评分、宫缩痛评分降低(P<0.05),术后4 h、48 h切口疼痛评分、宫缩痛评分2组比较差异无统计学意义。2组患者匹兹堡睡眠质量指数量表评分及阿森斯失眠量表评分比较,术后1 d NR组低于R组(P<0.05),2组患者术后2 d、3 d比较差异无统计学意义(P>0.05)。2组患者术后镇痛并发症发生率、Bromage评分、PCA按压次数差异无统计学意义(P>0.05)。结论与单纯使用罗哌卡因相比,纳布啡复合罗哌卡因用于剖宫产术后硬膜外镇痛,镇痛效果更好且可改善患者术后早期睡眠质量。Objective To observe the effects of epidural ropivacaine alone or combined with nalbuphine on analgesia and sleep quality in patients after cesarean section.Methods 60 ASAⅡ~Ⅲpatients,aged from 20 to 40 years old,with body mass index BMI≤30,scheduled for cesarean section under intraspinal anesthesia were randomly divided into R group(n=30,epidural 0.15%ropivacaine analgesia)and NR group(n=30,epidural 0.3 mg/mL nalbuphine+0.15%ropivacaine analgesia).The scores of pittsburgh sleep quality index and athens insomnia scale were recorded at the first day before operation,the first after operation,the second days after operation and third days after operation.Numerical rating scale(NRS),uterine contraction pain score(NRS),ramsay score,bromage score,effective pressing times and postoperative complications of postoperative patient-controlled analgesia were recorded in both groups at 4 h,12 h,24 h and 48 h after operation.Results Compared with group R,the pain score and uterine contraction pain score of group NR decreased at 12 h and 24 h after operation(P<0.05),but there was no significant difference between the two groups at 4 h and 48h after operation(P>0.05).One day after operation,the scores of pittsburgh sleep quality Index scale and athens insomnia scale in group NR were lower than those in group R(P<0.05).The incidence of postoperative analgesic complications in group R(23%)was lower than that in group NR(30%).There was no significant difference in postoperative 2 d and 3 d between 2 groups(P>0.05).There was no significant difference in the incidence of postoperative analgesia complications,Bromage score and PCA compression times between 2 groups(P>0.05).Conclusion Compared with ropivacaine alone,epidural analgesia with nalbuphine combined with ropivacaine can reduce the postoperative pain score and improve the sleep quality of patients after cesarean section.

关 键 词：病人自控硬膜外镇痛 剖宫产术 睡眠质量 罗哌卡因 纳布啡 

分 类 号：R614[医药卫生—麻醉学]