纳布啡用于剖宫产术后自控静脉镇痛的可行性

Feasibility of nalbuphine for patient-controlled intravenous analgesia after cesarean section

目的初步评价盐酸纳布啡用于剖宫产术后自控静脉镇痛(PCIA)的有效性及安全性。方法本研究为单臂临床试验,孕产妇60例,年龄20~44岁,体重50~80 kg,ASA分级Ⅰ或Ⅱ级,在硬膜外麻醉下行剖宫产术。当产妇术后疼痛VAS评分≥3分时,开始实施PCIA:静脉注射纳布啡10 mg作为负荷剂量,镇痛泵配方:110 mg纳布啡加生理盐水至200 ml,背景输注速率4 ml/h,PCA剂量2 ml/h,锁定时间15 min。观察术后48 h期间静态痛、动态痛和宫缩痛的VAS评分、Ramsay评分及不良反应的发生情况。结果静态痛、动态痛和宫缩痛的VAS评分均≤3分,维持Ramsay评分2~4分,血液动力学指标均维持在正常范围,未见恶心呕吐、嗜睡、多汗、眩晕、皮肤瘙痒、呼吸抑制等不良反应发生。结论纳布啡PCIA按照以上方式用于剖宫产术后镇痛具有良好的可行性。

Objective To preliminarily evaluate the effectiveness and safety of nalbuphine for patient-controlled intravenous analgesia(PCIA)after cesarean section.Methods This study was a single arm clinical trial.Sixty parturients,aged 20-44 yr,weighing 50-80 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,scheduled for cesarean section with epidural anesthesia,were enrolled in this study.PCIA was performed when visual analogue scale(VAS)score for postoperative pain≥3 points following cesarean section.A bolus of nalbuphine 10 mg was intravenously injected as a loading dose.PCIA pump solution contained 110 mg nalbuphine diluted to 200 ml with normal saline.The pump was set up with a background infusion at a rate of 4 ml/h,2 ml bolus dose and 15 min lockout interval.The VAS scores for pain at rest and during activity and uterine contraction pain,Ramsay sedation scores and adverse reactions were observed within 48 h after surgery.Results The VAS scores for pain at rest and during activity and uterine contraction pain were all≤3 points,the Ramsay scores were maintained at 2-4 points,hemodynamic parameters were maintained in the normal range,and no adverse reactions such as nausea and vomiting,drowsiness,hyperhidrosis,dizziness,pruritus,and respiratory depression occurred.Conclusion PCIA with nalbuphine given according to the method mentioned above has good feasibility when used for analgesia following cesarean section.