纳布啡联合右美托咪定多模式镇痛对疤痕子宫再次剖宫产术后镇痛的影响

The effect of nalbuphine combined with dexmedetomidine multimodal analgesia on postoperative analgesia for patients with repeat cesarean section

目的观察右美托咪定混合罗哌卡因行双侧腹横肌平面阻滞(TAPB)联合低剂量纳布啡病人静脉自控镇痛(PCIA)对疤痕子宫再次剖宫产术后宫缩痛的影响。方法选取2019年4—8月在合肥市妇幼保健院行腰麻下疤痕子宫再次剖宫产产妇60例,根据随机数字表法分为2组:纳布啡常规剂量组(NC组),纳布啡低剂量联合罗哌卡因、右美托咪定TAPB组(NDT组),每组30例。NDT组于术后在超声引导下行双侧TAPB,每侧注入罗哌卡因与右美托咪定混合液30 mL。记录2组术后VAS评分、睡眠时间、不良反应发生率、首次下床时间、镇痛满意度等。结果NDT组术后6、12、24、36、48 h时点宫缩痛VAS评分[2.0(1.0,3.0)分、3.0(2.0,3.0)分、2.0(2.0,3.0)分、2.0(2.0,2.0)分、2.0(1.0,2.0)分]均显著低于NC组[4.0(3.0,5.0)分、4.0(4.0,5.0)分、4.0(3.0,5.0)分、3.0(2.8,4.0)分、2.0(2.0,3.0)分,均P<0.05];术后24、48 h睡眠时间显著长于NC组[8.0(7.0,8.0)h/d、8.0(7.0,8.0)h/d vs.5.0(4.8,6.0)h/d、6.0(6.0,7.0)h/d,均P<0.05]。NDT组首次下床时间显著缩短,术后恶心呕吐、头晕发生率显著降低,产妇镇痛满意度显著增高。结论低剂量纳布啡PCIA联合罗哌卡因、右美托咪定TAPB多模式镇痛方案用于疤痕子宫再次剖宫产术后镇痛效果满意且不良反应少。

Objective To observe the effect of dexmedetomidine plus ropivacaine in bilateral transverse abdominal plane block(TAPB)combined with patient-controlled intravenous analgesia(PCIA)in patients with low-dose naborphine on uterine contraction pain after cesarean section of scarred uterus.Methods From April to August 2019,60 pregnant women who underwent cesarean section of scar uterus under spinal anesthesia in Hefei Maternal and Child Health Hospital were randomly divided into two groups:naborphine conventional dose group(NC group),naborphine low dose combined with ropivacaine and dexmedetomidine TAPB group(NDT group),with 30 cases in each group.The group of NDT received bilateral TAPB under ultrasound guidance after cesarean section,30 mL of ropivacaine and dexmedetomidine mixture was injected into each side.Visual analog score(VAS),sleep time,incidence of adverse reactions,time of getting out of bed for the first time and satisfaction with analgesia were recorded in the two groups.Results The VAS scores of uterine contraction pain at 6,12,24,36 and 48 hours after operation in NDT group[2.0(1.0,3.0),3.0(2.0,3.0),2.0(2.0,3.0),2.0(2.0,2.0),2.0(1.0,2.0)vs.4.0(3.0,5.0),4.0(4.0,5.0),4.0(3.0,5.0),3.0(2.8,4.0),2.0(2.0,3.0),all P<0.05].The sleep time at 24 and 48 hours after operation in NDT group was significantly longer than that in NC group[5.0(4.8,6.0)h/d,6.0(6.0,7.0)h/d vs.8.0(7.0,8.0)h/d,8.0(7.0,8.0)h/d,all P<0.05].In NDT group,the first time out of bed was significantly shortened,the incidence of postoperative nausea,vomiting and dizziness were significantly reduced,and the satisfaction of maternal analgesia was significantly increased.Conclusion Low dose nalbuphine PCIA combined with ropivacaine,dexmedetomidine and TAPB multimodal analgesia regimen for postoperative analgesia of scar uterus after cesarean section has satisfactory effect and less adverse reactions.