不同剂量纳布啡联合瑞芬太尼自控镇痛在剖宫产术后的应用  

Application of different doses of nalbuphine combined with remifentanil in self-controlled analgesia after cesarean section

作　　者：黄岩 王丽霞[2] 张莹莹 HUANG Yan;WANG Lixia;ZHANG Yingying(Department of Anesthesiology,the Second People's Hospital of Mengcheng County,Bozhou 233500,Anhui,China;Department of Anesthesiology,the First Affiliated Hospital of Anhui Medical University,Hefei 230022,Anhui,China;Department of Obstetrics and Gynecology,the Second People's Hospital of Mengcheng County,Bozhou 233500,Anhui,China)

机构地区：[1]蒙城县第二人民医院麻醉科,安徽亳州233500 [2]安徽医科大学第一附属医院麻醉科,安徽合肥230022 [3]蒙城县第二人民医院妇产科,安徽亳州233500

出　　处：《中南医学科学杂志》2025年第2期276-279,共4页Medical Science Journal of Central South China

基　　金：安徽省重点研究与开发计划(202104j07020013)。

摘　　要：目的 探讨不同剂量纳布啡联合瑞芬太尼自控镇痛在剖宫产术后的应用。方法 选择行剖宫产的产妇78例,根据纳布啡剂量均分为低剂量组(1.2 mg/kg)、中剂量组(2.2 mg/kg)和高剂量组(3.2 mg/kg)。各组术后通过自控镇痛分别给予相应剂量纳布啡联合0.3μg/kg瑞芬太尼。观察各组给药1 h和给药12 h后镇痛效果[视觉模拟评分(VAS)]和镇静效果(Ramsay评分)。比较各组术前、给药1 h和给药6 h时心率(HR)、平均动脉压(MAP)以及术前和给药1 h后血清泌乳素(PRL)、血浆皮质醇(Cor)水平。统计各组治疗过程中不良反应的发生情况。结果 给药12 h后,高剂量组、中剂量组和低剂量组VAS评分依次升高(P<0.05),Ramsay评分依次降低(P<0.05)。给药1 h后各组血清PRL均高于术前,中剂量组高于低剂量组和高剂量组(P<0.05);而各组血浆Cor均低于术前,中剂量组低于低剂量组和高剂量组(P<0.05)。低剂量组、高剂量组HR、MAP水平随着时间递增而升高(P<0.05);给药6 h后,中剂量组HR、MAP水平低于低剂量组和高剂量组(P<0.05),低剂量组低于高剂量组(P<0.05)。高剂量组不良反应发生率高于低剂量组和中剂量组(P<0.05)。结论 2.2 mg/kg纳布啡联合瑞芬太尼在剖宫产术后镇静镇痛效果最好,能够维持血流动力学稳定,抑制应激反应,并降低不良反应发生率,是一种安全有效的剖宫产术后镇痛方案。Aim To study the use of different doses of nalbuphine combined with remifentanil for self-controlled analgesia after cesarean section.Methods Totally 78 postpartum women who underwent cesarean section in our hospital were divided into low-dose(1.2 mg/kg),medium-dose(2.2 mg/kg),and high-dose groups(3.2 mg/kg) based on the use of different doses of nalbuphine.After surgery,each group was given corresponding doses of nalbuphine combined with 0.3 μg/kg remifentanil.The analgesic effect(Visual Analog Scale(VAS)) and sedative effect(Ramsay score) of each group were observed after 1 hour and 12 hours of administration.The heart rate(HR),mean arterial pressure(MAP),prolactin(PRL),and plasma cortisol(Cor) levels of each group before surgery,1 hour after administration,and 6 hours after administration were compared.The occurrence of adverse reactions during the treatment process was recorded.Results After 12 h of administration,VAS scores in the high-dose group,medium-dose group,and low-dose group increased sequentially(P<0.05),while Ramsay scores decreased sequentially(P<0.05).After 1 h of administration,the serum PRL levels in all groups were higher than the levels before surgery,and the medium-dose group was higher than the low-dose group and high-dose group(P<0.05);the plasma Cor levels in all groups were lower than the levels before surgery,with the medium-dose group being lower than the low-dose and high-dose groups(P<0.05).The HR and MAP levels in the low-dose and high-dose groups increased with time(P<0.05);After 6 h of administration,the HR and MAP levels in the medium dose group were lower than those in the low-dose and high-dose groups(P<0.05),and the low-dose group was lower than the high-dose group(P<0.05).The incidence of adverse reactions in the high-dose group was higher than that in the low-dose and medium dose groups(P<0.05).Conclusion When the dose of nalbuphine is 2.2 mg/kg,the combination of remifentanil has the best sedative and analgesic effect after cesarean section,which can maintain hemodynamic s

关 键 词：纳布啡 瑞芬太尼 自控镇痛 剖宫产 

分 类 号：R614[医药卫生—麻醉学]