地佐辛与纳布啡用于剖宫产术后静脉自控镇痛的临床观察

Clinical Observation of Dezocine and Nalbuphine on Patient-controlled Intravenous Analgesia in Patients Undergoing Cesarean Section

目的:比较地佐辛与纳布啡用于剖宫产术后静脉自控镇痛(PCIA)的效果和安全性。方法:选择2015年6月-2017年3月在我院行择期剖宫产术的患者97例,采用抽签表法分为地佐辛组(52例)和纳布啡组(45例)。两组患者均在腰-硬联合麻醉下行剖宫产术,术后立即连接PCIA泵,其中地佐辛组PCIA泵配方为地佐辛注射液0.5 mg/kg+盐酸托烷司琼注射液10 mg,纳布啡组PCIA泵配方为纳布啡2 mg/kg+盐酸托烷司琼注射液10 mg,两组镇痛药物均用0.9%氯化钠注射液稀释至100 mL,药液恒定泵入速度为2 mL/h,单次追加剂量为0.5 mL,持续泵入48 h。两组患者均于术后4、8、12、24、48 h时评估其静息痛、动态痛及子宫收缩痛视觉模拟(VAS)评分和Ramsay镇静评分,于术前30 min及术后24、48 h时检测血清泌乳素(PRL)水平,记录两组患者泌乳始动时间及不良反应发生情况等。结果:地佐辛组患者术后4、8、12 h时的静息痛和子宫收缩痛VAS评分及术后4、8、12、24 h时的动态痛VAS评分均显著低于纳布啡组,差异均有统计学意义(P<0.05),其他时间点的组间VAS评分比较,差异均无统计学意义(P>0.05);且随着时间的推移两组患者各时间点的VAS评分均显著降低,差异均有统计学意义(P<0.05)。两组患者术后24、48 h时的血清PRL水平均显著高于术前30 min,差异均有统计学意义(P<0.05);而两组患者手术前后各时间点血清PRL水平比较,差异均无统计学意义(P>0.05)。两组患者术后各时间点的Ramsay镇静评分、泌乳始动时间及不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:地佐辛和纳布啡均为剖宫产术后PCIA的有效镇痛药物,地佐辛在剖宫产术后早期的镇痛效果优于纳布啡,而两组远期镇痛效果和术后镇静效果相当,对患者术后血清PRL水平、泌乳始动时间的影响及安全性方面均类似。

ABSTRACT OBJECTIVE：To compare the effects of dezocine and nalbuphine on patient-controlled intravenous analgesia（PCIA）in patients undergoing cesarean section. METHODS：A total of 97 patients undergoing selective cesarean section were selected from our hospital during Jun. 2015 to Mar. 2017. They were divided into dezocine group（52 cases）and nalbuphine group（45 cases） according to lottery. Both groups received cesarean section under combined spinal-epidural anesthesia,and then given PCIA pump immediately after surgery. The pump of dezocine group was Dezocine injection 0.5 mg/kg＋Tropisetron hydrochloride injection 10 mg;that of nalbuphine group was Nalbuphine hydrochloride injection 2 mg/kg＋Tropisetron hydrochloride injection 10 mg. Both groups of analgesic drugs were diluted 100 mL with 0.9% sodium chloride injection,constant infusion of liquid medicine at rate of 2 mL/h,adding 0.5 mL additionally each time,for consecutive 48 h. VAS score and Ramsay sedation score of resting pain,dynamic pain and uterine contraction pain were performed in 2 groups 4,8,12,24,48 h after surgery. The serum levels of PRL were determined 30 min before surgery and 24,48 h after surgery. The initial time of lactation and ADR were recorded in 2 groups.RESULTS：VAS score of resting pain and uterine contraction pain at 4,8,12 h after operation and that of dynamic pain at 4,8,12,24 h after operation were significantly lower in dezocine group than nalbuphine group,with statistical significance （P〈0.05）.There was no statistical significance in VAS score between 2 groups at other time points（P〉0.05）. As time went on,the VAS scores of the two groups decreased significantly at each time point,and the difference was statistically significant（P〈0.05）. The serum levels of PRL in 2 groups 24 and 48 h after operation were significantly higher than 30 min before operation,with statistical significance（P〈0.05）. There was no statistical significance in serum level of PRL between 2 groups at same time point（P〉0.05）. There was no statistical significance in Ramsay score,initial time of lactation or the incidence of ADR between dezocine group and nalbuphine group （P〉0.05）.CONCLUSIONS：Both dezocine and nalbuphine are effective analgesia drugs of PCIA in patients undergoing cesarean section. Early postoperative analgesic effect of dezocine is superior to nalbuphine. They have similar effects on long-term analgesia and postoperative sedative,serum level of PRL,initial time of lactation,as well as safety.