纳布啡联合瑞芬太尼用于剖宫产术后静脉自控镇痛的效果  

Effect of nalbuphine combined with remifentanil intravenous self-control on postoperative analgesia

作　　者：冯定祥[1] 付梅苏 羊瑛 包丽霞[1] 王莹[1] FENG Dingxiang;FU Meisu;YANG Ying;BAO Lixia;WANG Ying(People's Hospital of Panan County,Pan'an 322300,China)

机构地区：[1]磐安县人民医院,浙江磐安322300

出　　处：《浙江实用医学》2024年第4期295-298,共4页Zhejiang Practical Medicine

摘　　要：目的 评价纳布啡与瑞芬太尼联合麻醉用于剖宫产术后PCIA中的疗效及安全性。方法 选取2023年1~6月在浙江省磐安县人民医院实施剖宫产手术的96例产妇,按随机数字表法分为瑞芬太尼组48例,术后行瑞芬太尼PCIA;联合组48例,术后行纳布啡联合瑞芬太尼PCIA。记录比较两组术后3、6、9、12、24小时咳嗽时VAS评分及Ramsay评分;术后24小时的PRL水平及术后泌乳启动时间;术后不良反应发生情况。结果 联合组术后6、9小时咳嗽时VAS评分低于瑞芬太尼组(P<0.01);联合组术后24小时的PRL水平高于瑞芬太尼组(P<0.01);联合组产妇产后泌乳水平(泌乳起始时间≤24小时)优于瑞芬太尼组(P<0.05);联合组PCIA按压次数、恶心/呕吐发生率均少于瑞芬太尼组(P<0.05)。结论 纳布啡联合瑞芬太尼用于剖宫产术后PCIA的镇痛效果理想,不良反应较轻,且对产妇术后PRL分泌的影响较少。Objective To evaluate the efficacy and safety of combined nabilone and remifentanil for postoperative patient-controlled analgesia(PCIA)in cesarean section.Method A total of 96 parturients undergoing cesarean section at Pan’an People’s Hospital of Zhejiang Province from January to June 2023 were randomly divided into two groups:the remifentanil group(n=48)and the nabilone-remifentanil group(n=48).Postoperative analgesia was provided by PCIA with remifentanil or a combination of nabilone and remifentanil,respectively.The primary outcome measures were the Visual Analog Scale(VAS)and Ramsay Sedation Score at 3,6,9,and 12 hours postoperatively,as well as the prolactin(PRL)level and time to lactation initiation at 24 hours postoperatively.Secondary outcome measures included the incidence of adverse events.Result Compared with the remifentanil group,the nabilone-remifentanil group had significantly lower VAS scores at 6 and 9 hours postoperatively(P<0.01),higher PRL levels at 24 hours postoperatively(P<0.01),and an earlier onset of lactation(within 24 hours)(P<0.05).Moreover,the nabilone-remifentanil group had significantly fewer PCIA bolus requests and incidences of nausea and vomiting(P<0.05).Conclusion The combination of nabilone and remifentanil for postoperative PCIA in cesarean section provides ideal analgesia with fewer adverse effects and has minimal impact on postpartum PRL secretion.

关 键 词：剖宫产 PCIA 纳布啡 瑞芬太尼 

分 类 号：R614[医药卫生—麻醉学] R719.8[医药卫生—外科学]