摘要
目的研究纳布啡复合罗哌卡因用于硬膜外分娩镇痛的效果。方法自愿选择分娩镇痛的单胎初产妇180例,年龄20~40岁,BMI 18~35 kg/m^2,ASAⅠ或Ⅱ级,采用随机数字表分为纳布啡组(NR组)和舒芬太尼组(SR组),每组90例。NR组产妇在宫口开至约2 cm时,给予0.3 mg/ml纳布啡复合0.1%盐酸罗派卡因行患者自控硬膜外镇痛(PCEA)。SR组产妇给予0.3μg/ml舒芬太尼复合0.1%盐酸罗派卡因行PCEA。记录镇痛起效时间、首次PCA时间、PCA药物总量和罗哌卡因消耗量等。观察镇痛前(T 0)、镇痛30 min(T 1)、60 min(T 2)、宫口开全(T 3)、分娩时(T 4)和产后2 h(T 5)时VAS评分、Ramsay镇静评分、改良Bromage评分、BP、HR、SpO 2。记录新生儿脐动脉血气和神经适应能力评分(NBNA)、产妇首次泌乳时间、出血量和恶心呕吐、皮肤瘙痒等不良反应发生率。结果与SR组比较,NR组镇痛起效时间明显增快(P<0.05),首次PCA时间明显缩短(P<0.05),PCA药物总量、PCA按压次数、有效按压次数和罗哌卡因消耗量明显增加(P<0.05),T 3时VAS评分明显升高(P<0.05)。两组产妇Ramsay镇静评分、改良Bromage评分、BP、HR、SpO 2、首次泌乳时间等差异无统计学意义。两组新生儿脐动脉血气和NBNA评分等差异无统计学意义。结论与舒芬太尼比较,纳布啡用于硬膜外分娩镇痛起效较快,但在宫口开全时VAS评分和罗哌卡因消耗量较高。两者都能明显降低分娩疼痛,并且都对患儿脐动脉血气和NBNA评分无影响。
Objective To investigate the effect of nalbuphine combined with ropivacaine on continuous epidural labor analgesia and its maternal and infant effectiveness.Methods A total of 180 primiparas with a singleton at full term who voluntarily chose labor analgesia,aged 20-40 years,BMI 18-35 kg/m^2,falling into ASA physical statusⅠorⅡ,were double-blindly randomly divided into nalbuphine group(group NR)and sufentanil group(group SR),90 cases in each group.In group NR,parturients were given 0.3 mg/ml nalbuphine combined with 0.1%ropivacaine for patient-controlled epidural analgesia(PCEA)when cervical dilation of 2 cm.In group SR,parturients were given 0.3μg/ml sufentanil combined with 0.1%ropivacaine for PCEA when cervical dilation of 2 cm.The onset time of analgesia,the first time of PCA,total amount of PCA drugs,and ropivacaine dose per hour were recorded.VAS score,Ramsay sedation score,modified Bromage score were recorded before analgesia(T 0),30 min(T 1),60 min(T 2)after beginning of analgesia,the uterine cervix fully dilated(T 3),during labor(T 4)and 2 h after delivery(T 5),respectively.Neonatal umbilical artery blood gas and neurological adaptability score(NBNA),the first lactation time of the parturients,amount of bleeding,incidence of nausea,vomiting,skin itching and other adverse reactions were recorded.Results Compared with group SR,the onset time of analgesia of the parturients in group NR was faster(P<0.05)but the first PCA time was shorter(P<0.05),total amount of PCA drugs,compressions,effective compressions and the consumption of ropivacaine were significantly increased(P<0.05).Compared with the group SR,the parturients in group NR had significantly higher VAS scores at T 3(P<0.05).There were no significant differences in Ramsay sedation score,modified Bromage score,BP,HR,SpO 2,and the first lactation time between the two groups.There were no significant differences between the two groups in terms of neonatal umbilical arterial blood gas and NBNA score.Conclusion Compared with sufentanil,nalbuphine has
作者
吴畏
孙鹏飞
范东梅
陈作雷
WU Wei;SUN Pengfei;FAN Dongmei;CHEN Zuolei(Department of Anesthesiology,Qingdao Women and Children’s Hospital,Qingdao University,Qingdao 266000,China)
出处
《临床麻醉学杂志》
CAS
CSCD
北大核心
2020年第11期1086-1090,共5页
Journal of Clinical Anesthesiology
