不同浓度纳布啡联合舒芬太尼+罗哌卡因PIEB注入在初产妇分娩镇痛中的应用效果及对新生儿脐动脉血气指标的影响  

Application Effects of PIEB with Different Concentrations of Nalbuphine Combined with Sufentanil and Ropivacaine in Labor Analgesia for Primiparae and the Influence on Neonatal Umbilical Artery Blood Gas Indicators

作　　者：刘鑫 LIU Xin(Department of Anesthesiology,Huainan Maternal and Child Health Hospital,Huainan 232000,China)

机构地区：[1]淮南市妇幼保健院麻醉科,安徽淮南232000

出　　处：《药物生物技术》2024年第6期688-692,共5页Pharmaceutical Biotechnology

摘　　要：分析不同浓度纳布啡联合舒芬太尼+罗哌卡因程控硬膜外间歇脉冲注入(PIEB)在初产妇分娩镇痛中的应用效果及对新生儿脐动脉血气指标的影响。选取2021年9月至2023年4月医院麻醉科采用PIEB及自控硬膜外镇痛(PCEA)行分娩镇痛的120名初产妇,采用随机数字表法分为N0组、N1组、N2组、N3组,每组各30例,N0组采用0.4μg/mL舒芬太尼+0.08%罗哌卡因,N1组、N2组及N3组在N0组基础上,分别采用0.03、0.06、0.09 mg/mL的纳布啡,对比各组分娩镇痛前后疼痛视觉模拟评分(VAS)、Ramsay镇静评分,记录其分娩过程中PCEA次数、镇痛相关不良反应、母婴结局及新生儿脐动脉血气指标。N2组、N3组镇痛后10、30 min时,VAS评分低于N0组同时点,N2组、N3组爆发痛发生率低于N0组、N1组,N1、N2、N3三组镇痛后30 min的Ramsay评分高于N0组(P<0.05);N0组分娩镇痛相关不良反应发生率高于其他三组,其中N2组不良发生率最低(P<0.05);N2组、N3组PCEA按压次数少于N0组(P<0.05);4组分娩方式及自然分娩产妇总产程、产后2 h出血量、新生儿出生后Apgar评分差异无统计学意义(P>0.05);4组新生儿脐动脉血气指标差异均无统计学意义(P>0.05)。不同浓度纳布啡联合舒芬太尼+罗哌卡因PIEB注入均可应用在初产妇分娩镇痛中,且对新生儿脐动脉血气指标无明显影响,其中0.06 mg/mL的纳布啡为适宜的配伍浓度。To analyze the application effects of programmed intermittent epidural bolus(PIEB)with different concentrations of nalbuphine combined with sufentanil and ropivacaine in labor analgesia for primiparae and the influence on neonatal umbilical artery blood gas indicators,120 primiparae who received labor analgesia via PIEB and patient-controlled epidural analgesia(PCEA)in the authors'hospital from September 2021 to April 2023 were randomly divided into NO group,N1 group,N2 group and N3 group with 30 cases in each group by random number table.Women in NO group received analgesia with sufentanil(O.4μg/mL)and ropivacaine(0.08%).On this basis,0.03 mg/mL,0.06 mg/mL and 0.09 mg/mL of nalbuphine were used in analgesia for N1 group,N2 group and N3 group,respectively.The visual analogue scale(VAS)scores and ramsay sedation scores before and after labor analgesia were compared among the 4 groups.Pressing times of PCEA during labor,analgesia related adverse reactions,maternal-infant outcomes,and neonatal umbilical artery blood gas indicators were recorded.At 10 min and 30 min after analgesia,VAS scores of N2 group and N3 group were lower than those of NO group at the same time point.The incidence rates of breakthrough pain in N2 group and N3 group were lower than those in NO group and NI group.At 30 min after analgesia,Ramsay score of N3 group was higher than that of NO group(P<0.05).The incidence of labor analgesia related adverse reactions in NO group was higher than those in the other 3 groups,and the incidence of adverse reactions in N2 group was the lowest(P<0.05).Pressing times of PCEA in N2 group and N3 group was lower than that in NO group(P<0.05).There was no statistically significant dfference among the 4 groups in terms of delivery mode,total labor duration in women undergoing natural delivery,2 h postpartum blood loss,neonatal Apgar score,and neonatal umbilical artery blood gas indicators(P>0.05).PIEB with different concentrations of nalbuphine combined with sufentanil and ropivacaine all can be used in labor anal

关 键 词：浓度 纳布啡 舒芬太尼 罗哌卡因 程控硬膜外间歇脉冲注入 初产妇 分娩镇痛 脐动脉血气分析 

分 类 号：R614[医药卫生—麻醉学]