不同剂量纳洛酮椎管内麻醉前给药对产妇和新生儿的影响  

Effect of administration with different doses of naloxone on puerpera and neonatal infants before intraspinal anesthesia

作　　者：许华强 钟增优 谢盛杰 杜瑞明 XU Huaqiang;ZHONG Zengyou;XIE Shengjie;DU Ruiming(Department of Anesthesiology,The Second Affiliated Hospital of Shantou University Medical College,Shantou 515041,Guangdong Province,China)

机构地区：[1]汕头大学医学院附属第二医院麻醉科,广东汕头515041

出　　处：《药学前沿》2024年第12期657-662,共6页China Pharmacist

基　　金：汕头市第二批医疗卫生科技计划(自筹经费类)项目(汕府科﹝2020﹞58号)。

摘　　要：目的探究不同剂量纳洛酮(NAL)椎管内麻醉前给药对产妇和新生儿的影响。方法分析2020年8月至2023年6月汕头大学医学院第二附属医院行椎管内分娩镇痛产妇临床资料。根据椎管内麻醉前NAL给药剂量分为对照组(NAL 0μg)、NAL-A组(NAL40μg)和NAL-B组(NAL80μg)。本研究观察指标包括产妇情况[视觉模拟量表(VAS)评分、自控镇痛泵(PCA)按压次数、产程时间、并发症发生情况]和新生儿情况[体重、Apgar评分、脐动脉血pH值、二氧化碳分压(PCO_(2))和氧分压(PO_(2))]。结果研究共纳入产妇236例,NAL-A组77例,NAL-B组79例,对照组80例。NAL剂量增加,产妇VAS评分和PCA按压次数逐渐减少(P<0.05)。NAL-B组第一产程、第二产程和不良反应发生率均显著低于NAL-A组和对照组(P<0.05);3组新生儿体重、Apgar评分、脐动脉血pH值、PCO_(2)和PO_(2)差异无统计学意义(P>0.05)。结论80μg NAL椎管内麻醉前给药镇痛效果较佳,可缩短产程时间,降低不良反应发生率,且对新生儿影响较小。Objective To investigate the effects of different doses of naloxone(NAL)administered on the puerpera and the newborn before intraspinal anesthesia.Methods The clinical data of women who underwent intraspinal labor analgesia at The Second Affiliated Hospital of Shantou University Medical College from August 2020 to June 2023 were analyzed.The patients were divided into three groups according to the dose of NAL given before intraspinal anesthesia:the control group(NAL 0μg),the NAL-A group(NAL 40μg),and the NAL-B group(NAL 80μg).The observed indicators include the puerpera’s condition(VAS score,PCA button presses,labor duration,complication incidence),and the newborn's condition(weight,Apgar score,umbilical artery blood pH value,PCO_(2) and PO_(2)).Results A total of 236 puerpera were included in the study,with 77 in the NAL-A group,79 in the NAL-B group,and 80 in the control group.Maternal VAS scores and the number of PCA presses gradually decreased with the increasing NAL dose(P<0.05).The first stage of labor,the second stage of labor,and the incidence of adverse reactions in the NAL-B group were significantly lower than those of the NAL-A group and the control group(P<0.05).The weights of the newborns,Apgar scores,umbilical artery blood pH,PCO_(2) and PO_(2) were not statistically significant in the three groups(P>0.05).Conclusion 80μg NAL administered before intraspinal anesthesia is more effective,which can shorten the duration of labor,reduce the incidence of adverse effects,and has less effect on the newborn.

关 键 词：纳洛酮 椎管内分娩镇痛 镇痛效果 不良反应 APGAR评分 视觉模拟量表评分 

分 类 号：R969.4[医药卫生—药理学]