不同剂量纳布啡预防给药对急诊剖宫产腰硬联合麻醉产妇术后镇痛效果的影响  

Effect of different doses of nalbuphine on analgesia effect after emergency cesarean section combined with lumbar and epidural anesthesia

作　　者：陈廷福 刘晶晶 张红 胡小丽 CHEN Tingfu;LIU Jingjing;ZHANG Hong;HU Xiaoli(Department of Anesthesiology,Chongqing Armed Police Corps Hospital,Chongqing 400061,China;Department of Anesthesiology,Beijing Armed Police Corps Hospital,Beijing 100027,China)

机构地区：[1]武警重庆总队医院麻醉科,重庆400061 [2]武警北京总队医院麻醉科,北京100027

出　　处：《新疆医科大学学报》2023年第10期1353-1358,共6页Journal of Xinjiang Medical University

基　　金：重庆市卫生计生委医药科技项目(ZY20180299)。

摘　　要：目的 探讨不同剂量纳布啡预防给药对急诊剖宫产腰硬联合麻醉产妇术后镇痛效果的影响。方法 选取在武警重庆总队医院行急诊剖宫产手术腰硬联合麻醉的产妇105例,以电脑随机数字表法将其分为对照组(n=35)、低剂量组(n=35)及高剂量组(n=35)。对照组给予0.9%的生理盐水4 mL,低剂量组予以0.9%的生理盐水稀释纳布啡0.08 mg/kg至4 mL,高剂量组予以0.9%的生理盐水稀释纳布啡0.12 mg/kg至4 mL,3组均在开放静脉后即刻静脉推注。比较3组手术及麻醉情况、术后不同时段数字等级评定量表(Digital rating scale, NRS)评分及补救镇痛情况、手术前后炎性水平,并评估孕妇及胎儿安全性。结果 3组手术指标(手术时间、术中输液量、术中失血量)及麻醉情况(试验药物给药至鞘内给药时间、鞘内给药至胎儿娩出时间)比较,差异均无统计学意义(P>0.05);术后6、12、24、48 h,高剂量组NRS评分及镇痛补救率均低于低剂量组、对照组(P<0.05),且低剂量组NRS分值及镇痛补救率低于对照组(P<0.05);与对照组比较,高剂量组产妇不良反应发生率较低(P<0.05);3组胎儿出生后指标[动脉血pH值和剩余碱(Base excess, BE)值,出生后1 min、5 min的Apgar评分]比较,差异均无统计学意义(P>0.05);与术前比较,3组术后24 h血清白细胞介素-6(interleukin 6,IL-6)、白细胞介素-1β(interleukin 1β,IL-1β)和肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)水平均升高(P<0.05);术后24 h,高剂量组血清IL-6、IL-1β、TNF-α低于低剂量组与对照组,低剂量组低于对照组(P<0.05)。结论 纳布啡0.08 mg/kg、0.12 mg/kg对急诊剖宫产的产妇均具有良好的术后镇痛效果,能有效地降低炎性细胞因子水平,及产妇术后并发症的发生率,且对新生儿无不良影响,但0.12 mg/kg的纳布啡效果更佳。Objective To investigate the effect of different doses of nalbuphine prophylactic administration on analgesia after emergency cesarean section and epidural anesthesia.Methods 105 puerpera who underwent emergency cesarean section operation in the hospital were selected and divided into control group(n=35),low-dose group(n=35)and high-dose group(n=35)by computer random number table.The control group was given 4 mL 0.9%normal saline,the low-dose group was given 0.9%normal saline diluted 0.08 mg/kg to 4 mL of nalbuphine,and the high-dose group was given 0.9%normal saline diluted 0.12 mg/kg to 4 mL of nalbuphine.All the 3 groups were injected intravenously immediately after the opening veins.Operation and anesthesia,digital rating scale(NRS)scores and relief analgesia at different time after the surgery,in-flammatory levels before and after the surgery were compared among the 3 groups,and the safety of preg-nant women and fetus were evaluated.Results There was no significant difference in surgical indexes(operation time,intraoperative infusion amount,intraoperative blood loss)and anesthesia(time from ex-perimental drug administration to intrathecal administration,time from intrathecal administration to fetal delivery)among the 3 groups(P>0.05).The NRS score and analgesic recovery rate of high-dose group were lower than those of low-dose group and control group(P<0.05),and the NRS score and analgesic recovery rate of low-dose group were lower than those of control group(P<0.05).The incidence of ad-verse reactions in high dose group was lower than control group(P<0.05).There were no significant differences in fetal postnatal indexes[arterial pH and residual alkali(BE),Apgar score 1 and 5 min after birth](P>0.05).Compared with pre-operation,serum interleukin 6(IL-6),interleukin 1β(IL-1β)and tumor necrosis factor-α(TNF-α)in 3 groups 24 hours after the surgery were increased(P<0.05).24 hours af-ter the operation,serum IL-6,IL-1βand TNF-αin high-dose group were lower than those in low-dose group and control group,and

关 键 词：急诊剖宫产 纳布啡 腰硬联合麻醉 镇痛 

分 类 号：R719.8[医药卫生—妇产科学] R614[医药卫生—临床医学]