纳布啡混合罗哌卡因用于剖宫产术后PCEA的适宜配伍

Optimum compatibility of nabupine mixed with ropivacaine for patient-controlled epidural analgesia after cesarean section

^目的评价纳布啡混合罗哌卡因用于剖宫产术后PCEA的适宜配伍。方法选择脊椎-硬膜外联合麻醉下单胎足月妊娠产妇100例,年龄24~35岁,BMI 29~33 kg/m2,ASA分级Ⅱ级,采用随机数字表法将产妇分为4组(n=25):舒芬太尼0.5μg/ml+0.15%罗哌卡因组(SR组)、纳布啡终浓度0.2 mg/ml+0.15%罗哌卡因组(N1R组)、纳布啡终浓度0.4 mg/ml+0.15%罗哌卡因组(N2R组)和纳布啡终浓度0.4 mg/ml+0.1%罗哌卡因组(N3R组)。术后按照分组情况进行PCEA药物配制,所有药物用生理盐水稀释至100 ml,背景剂量2.0 ml/h,PCA剂量0.5 ml,锁定时间15 min。维持术后48 h内切口痛和宫缩痛的VAS评分<4分;于术后8 h(T1)、12 h(T2)、24 h(T3)、48 h(T4)时记录Ramsay评分;记录术后48 h内PCEA总按压次数;记录镇痛期间恶心、呕吐、皮肤瘙痒、下肢麻木、尿潴留及呼吸抑制等不良反应的发生情况;于术前和术后24、48 h时采集产妇静脉血标本,检测血浆泌乳素浓度,记录新生儿初乳时间,于术后24、48 h时进行新生儿神经和适应能力评分。结果与SR组比较,N2R组和N3R组PCEA总按压次数减少(P<0.05),N1R组PCEA总按压次数差异无统计学意义(P>0.05);与N1R组比较,N2R组和N3R组PCEA总按压次数减少(P<0.05);N2R组和N3R组PCEA总按压次数比较差异无统计学意义(P>0.05)。4组Ramsay评分均为2分。4组下肢麻木发生率、血浆泌乳素浓度及新生儿神经和适应能力评分比较差异无统计学意义(P>0.05)。结论终浓度0.4 mg/ml纳布啡混合0.1%罗哌卡因为剖宫产术后PCEA的适宜配伍。

Objective To evaluate the optimum compatibility of nalbufine combined with ropivacaine for patient-controlled epidural analgesia(PCEA)after cesarean section.Methods A total of 100 parturients who were at full term with a singleton fetus,aged 24-35 yr,with body mass index of 29-33 kg/m^2,of American society of Anesthesiologists physical statusⅡ,scheduled for elective cesarean section under combined spinal-epidural anesthesia,were divided into 4 groups(n=25 each)using a random number table method:sufentanil 0.5μg/ml plus 0.15%ropivacaine group(SR group),nalbufine at final concentration of 0.2 mg/ml plus 0.15%ropivacaine group(N1R group),nalbufine at final concentration of 0.4 mg/ml plus 0.15%ropivacaine group(N2R group)and nalbufine at final concentration of 0.4 mg/ml plus 0.1%ropivacaine group(N3R group).PCEA solution was prepared correspondingly after surgery,and all the drugs were diluted to 100 ml in normal saline in each group.The PCA pump was set up to deliver a 0.5 ml bolus dose with a 15-min lockout interval and background infusion at 2 ml/h.Visual analog scale scores of incisional pain and anduterine contraction pain were maintained<4.Ramsay sedation scores were recorded at 8,12,24 and 48 h after surgery.The total pressing times of PCEA were recorded within 48 h after surgery.The development of adverse reactions such as nausea,vomiting,skin itching,numbness of lower extremity,urinary retention and respiratory depression was recorded in the analgesia period.Venous blood samples were collected before surgery and at 24 and 48 h after surgery for determination of plasma prolactin concentrations,and the time of colostrum was recorded.Neonatal nerve and adaptive capacity was assessed and scored.Results Compared with group SR,the total pressing times of PCEA were significantly reduced in N2R and N3R groups(P<0.05),and no significant change was found in the total pressing times of PCEA in group N1R(P>0.05).Compared with group N1R,the total pressing times of PCEA were significantly reduced in N2R and N3R groups(P<0.05).There was no significant difference in the total pressing times of PCEA between group N2R and group N3R(P>0.05).The Ramsay sedation score was 2 in four groups.There was no significant difference in numbness of lower extremity,plasma prolactin concentrations or neonatal nerve and adaptive capacity scores among four groups(P>0.05).Conclusion Nalbufine at final concentraction of 0.4 mg/ml mixed with 0.1%ropivacaine is the optimum compatibility when used for PCEA after cesarean section.