纳布啡复合罗哌卡因腰硬联合麻醉对分娩镇痛患者血浆促肾上腺皮质激素与皮质醇水平的影响

Effects of Nalbuphine Combined with Ropivacainethe Anethesia of Spinal and Epidural on Plasma ACTH and Cor Levels in Patients with Labor Analgesia

目的:探究纳布啡用于腰硬联合麻醉分娩镇痛中的效果及对产妇血浆促肾上腺皮质激素(ACTH)与皮质醇(COR)水平影响。方法:选取2019年1月至2021年11月在新余市中医院进行分娩并满足纳入条件的产妇114例为对象,按照随机分组原则将其分为对照组和研究组,每组57例。对照组给予产妇罗哌卡因+舒芬太尼进行腰硬联合麻醉分娩镇痛,研究组给予产妇罗哌卡因+纳布啡实施腰硬联合麻醉分娩镇痛。对比观察两组分娩镇痛前(T_(0))、分娩镇痛开始15 min(T_(1))、镇痛开始30 min(T_(2))以及宫口全开时(T_(3))视觉模拟评分(VAS)、血浆ACTH、Cor水平变化情况;比较新生儿行为神经评分(NABA),并对比两组产妇不良反应发生情况。结果:VAS评分比较,两组T_(0)时对比差异无统计学意义(P>0.05),研究组T_(1)、T_(2)、T_(3)各时间段VAS评分则小于对照组(P<0.05);分娩后2 h,两组ACTH、Cor水平均下降,组间比较,研究组ACTH、Cor水平低于对照组(P<0.05);两组新生儿NABA评分对比,差异无统计学意义(P>0.05);产妇不良反应对比,研究组为5.26%,低于对照组的17.54%(P<0.05)。结论:纳布啡联合罗哌卡因用于腰硬分娩镇痛中,镇痛效果显著,能够减轻产妇应激水平,同时不会对母婴安全带来影响。

Objective:To investigate the effect of nalbuphine on the anethesia of spinal and epidural and the effects on the levels of plasma adrenocorticotropic hormone(ACTH)and cortisol(Cor)in patierts with labor Analgesia.Methods:A total of 114 cases of pregnant women who delivered in Xinyu Hospital of Traditional Chinese Medicine from January 2019 to November 2021 and met the inclusion conditions were selected as the objects,and they were divided into control group and research group according to the principle of random grouping,with 57 cases in each group.The control group was given ropivacaine and sufentanil inanethesia of spinal epidural for labor analgesia,while the study group was given ropivacaine and nalbuphine in anethesia of spinal-epidural for labor analgesia.Analgesia was assessed using a visual analog scale(VAS)immediately before analgesia(T_(0))and 15(T_(1)),30 minutes(T_(2))after induction of the analgesia and time of the cervical open fully(T_(3)).Plasma ACTH and Cor were compared between the two groups in different time periods.Neonatal behavioral neuroblogical scores were compared,and the incidence of adverse reactions in the two groups was compared.Results:There was no significant difference in VAS scores between the two groups at T_(0)(P>0.05),but VAS scores in the study group at T_(1),T_(2) and T_(3) were lower than those in the control group(P<0.05).Two hours after delivery,ACTH and COR levels were descend in both groups,but the ACTH and Cor levels in the research group were lower than those in the control group(P<0.05).There was no significant difference in NABA score between the two groups(P>0.05).Comparison of maternal adverse reactions,the study group was 5.26%,which was lower than that in the control group 17.54%(P<0.05).Conclusion:Nalbuphine has a significant analgesic effect in spinalepidural l labor analgesia,can reduce the stress level of maternal,and will not affect the safety of mother and child.