纳布啡用于剖宫产术后硬膜外自控镇痛的临床观察

Clinical investigation of nalbuphine used in PCEA after cesarean section

目的观察纳布啡复合罗哌卡因用于剖宫产术后硬膜外自控镇痛(PCEA)的临床效果及不良反应,并将其安全性及有效性与舒芬太尼进行比较。方法选择2015年10月-2016年1月在吉林大学第一医院腰硬联合阻滞麻醉下行剖宫产手术的足月初产妇60例,ASAⅠ~Ⅱ级,术后镇痛采用PCEA模式。将产妇随机分为A组和B组各30例,A组为纳布啡0.2 mg/ml复合0.15%罗哌卡因组,B组为舒芬太尼0.4μg/ml复合0.15%罗哌卡因组。观察两组镇痛后4、8、12和24 h产妇的切口痛以及宫缩痛视觉模拟(VAS)评分、Ramsay镇静评分,记录24 h内恶心、呕吐、皮肤瘙痒、尿潴留等不良反应的发生率。结果两组行剖宫产妇术后各时间点的切口痛VAS评分相似,差异无统计学意义(P>0.05);A组产妇宫缩痛VAS评分低于B组产妇,差异有统计学意义(P<0.05);A组产妇不良反应发生率及各时间点的Ramsay镇静评分与B组比较差异无统计学意义(P>0.05)。结论 0.2 mg/ml纳布啡复合0.15%罗哌卡因用于剖宫产术后镇痛效果满意,可推广用于临床。

Objective To observe the clinical efficacy and side effects of nalbuphine combined with ropivacaine used in patient-control epidural analgesia（ PCEA） after cesarean section,compare the safety and efficacy between nalbuphine and sufentanyl.Methods Sixty full-term primiparous women（ ASAⅠ-Ⅱ） underwent cesarean section under combined spinal-epidural analgesia（ CSCA） in the hospital from October 2015 to January 2016,PCEA was adopted after delivery.All the primiparous women were randomly divided into group A and group B,30 women in each group.The patients in group A were treated by nalbuphine（ 0.2 mg/ml） combined with ropivacaine（ 0.15%）,and the patients in group B were treated by sufentanyl（ 0.4 μg/ml） combined with ropivacaine（ 0.15%）.Visual analogue scale（ VAS）scores of incision and uterine contraction and Ramsay sedation scores at 4,8,12,and 24 hours after analgesia were observed in the two groups.The incidence rates of adverse reactions（ nausea,vomiting,skin itch and urinary retention） within 24 hours were recorded.Results There was no statistically significant difference in VAS scores of incision at different time points after cesarean section between the two groups（ P〉0.05）; VAS score of uterine contraction in group A was statistically significantly lower than that in group B（ P〈0.05）;there was no statistically significant difference in the incidence rates of adverse reactions and Ramsay sedation scores at different time points after cesarean section between the two groups（ P〉0.05）.Conclusion The analgesic effect of nalbuphine（ 0.2 mg/ml） combined with ropivacaine（ 0.15%） used for analgesia after cesarean section is satisfactory,which is worthy of clinical promotion.