剖宫产术后纳布啡的镇痛效果及对血清免疫-炎症因子水平的影响  

Analgesic effect of nalbuphine after cesarean section and its impact on serum immune-inflammatory factor levels

作　　者：冬飓 李正鸿 王玉玉 程财清 马智娟 DONG Ju;LI Zhenghong;WANG Yuyu;CHENG Caiqing;MA Zhijuan(Department of Anesthesiology,Xining Third People's Hospital,Xining,Qinghai 810000,China)

机构地区：[1]西宁市第三人民医院麻醉科,青海西宁810000

出　　处：《安徽医药》2025年第3期623-628,共6页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探究纳布啡复合舒芬太尼在剖宫产术后镇痛中的效果及对血清免疫-炎症因子水平的影响。方法选取2021年4月至2023年4月西宁市第三人民医院120例剖宫产孕妇,按照随机数字表法分为对照组和研究组,各60例。两组均行腰-硬联合麻醉,术后给予对照组舒芬太尼自控静脉镇痛(PCIA),给予研究组纳布啡复合舒芬太尼PCIA。比较两组围手术期情况、镇痛镇静效果[静息和活动时视觉模拟评分法(VAS)评分、Ramsay镇静评分]、免疫-炎症因子[CD3^(+)、CD4^(+)/CD8^(+)、可溶性人肿瘤坏死因子受体2(sTNFR-2)、白细胞介素-6(IL-6)]、血清微RNA-206、长链非编码RNA FOXD2-AS1(LncRNA FOXD2-AS1)水平、不良反应、满意度和舒适度。结果研究组术后自主排尿、首次下床活动时间分别为(19.21±2.56)h、(11.81±3.29)h,短于对照组的(24.18±3.17)h、(14.93±3.35)h,舒芬太尼用量、总按压次数分别为(456.78±82.71)μg、(9.12±1.53)次,少于对照组的(640.53±115.64)μg、(12.81±1.94)次,均差异有统计学意义(P<0.05);研究组术后3、6、12、24、48 h静息和活动时VAS评分低于对照组,均差异有统计学意义(P<0.05);研究组术后24、48 h血清CD3^(+)、CD4^(+)/CD8^(+)水平高于对照组,sTNFR-2、IL-6水平低于对照组,均差异有统计学意义(P<0.05);研究组不良反应发生率为6.67%,与对照组的10.00%比较差异无统计学意义(P>0.05);研究组满意度评分、舒适度评分分别为(3.35±0.29)分、(3.21±0.46)分,高于对照组的(2.97±0.25)分、(2.85±0.51)分,均差异有统计学意义(P<0.05)。结论剖宫产腰-硬联合麻醉中采用纳布啡复合舒芬太尼进行PCIA能改善镇痛效果,且未增加不良反应发生。Objective To investigate the effect of nalbuphine combined with sufentanil in postoperative analgesia after cesarean section and the effect on serum immune-inflammatory factor levels.Methods A total of 120 cases of pregnant women undergoing cesarean section in the Third People's Hospital of Xining City from April 2021 to April 2023 were selected.They were divided into control and study groups according to the random digital table method,60 cases in each group.Both groups underwent combined lumbar-rigid anesthesia,and postoperative sufentanil patient-controlled intravenous analgesia(PCIA)was given to the control group,while nalbuphine combined with sufentanil PCIA was given to the study group.The perioperative conditions,analgesic and sedative effects[Visual analogue scale(VAS)scores during rest and activity,Ramsay sedative scores],immune-inflammatory factors[CD3^(+),CD4^(+)/CD8^(+),soluble human tumor necrosis factor receptor 2(sTNFR-2),interleukin-6(IL-6)],serum microRNA-206(miR-206),long chain non coding RNA FOXD2-AS1(LncRNA FOXD2-AS1)levels,adverse reactions,satisfaction,and comfort were compared between the two groups.Re⁃sults The postoperative self-urination and first ambulation time in the study group were(19.21±2.56)hours and(11.81±3.29)hours,respectively,which were shorter than those in the control group(24.18±3.17)hours and(14.93±3.35)hours.The amount of sufentanil used and the total number of compressions were(456.78±82.71)μg and(9.12±1.53)times,respectively,which were less than those in the control group(640.53±115.64)μg and(12.81±1.94)times,with significant differences(P<0.05).The VAS scores of the study group at rest and during activity at 3,6,12,24,and 48 hours after surgery were lower than those of the control group,and the differences were statistically significant(P<0.05).The levels of serum CD3^(+),CD4^(+)/CD8^(+)in the study group were higher than those in the control group at 24 h and 48 h after surgery,while the levels of sTNFR-2 and IL-6 were lower than those in the control group

关 键 词：剖宫产术 麻醉 硬膜外 麻醉 脊椎 镇痛 纳布啡 舒芬太尼 免疫-炎症因子 

分 类 号：R614[医药卫生—麻醉学]