纳美芬对单次蛛网膜下腔阻滞行剖宫产术后吗啡镇痛的影响

Effect of Nalmefene on Morphine Analgesia After Cesarean Section with Single Subarachnoid Block

目的观察纳美芬静脉给药对剖宫产术后蛛网膜下腔吗啡镇痛的影响。方法选择朝阳市第二医院2020年1月至2020年12月100例拟在单次蛛网膜下腔阻滞下行剖宫产术的产妇作为研究对象。采用数表随机法分为对照组50例、纳美芬组50例,两组均于蛛网膜下腔穿刺成功后给予0.5%重比重的布比卡因(10 mg)与吗啡(0.2 mg)的混合液。手术结束时对照组不采用药物干预;纳美芬组给予给予0.1μg/kg纳美芬5 mL静脉注射,术后第3、6、12、24小时评估疼痛程度,记录两组患者恶心、呕吐、皮肤瘙痒、下肢麻木等并发症发生率。结果两组剖宫产术后第3、6、12、24小时疼痛程度两组间比较差异均无统计学意义(P>0.05)。纳美芬组恶心、呕吐、瘙痒的发生率为分别为4.00%、0.00%、2.00%;均低于对照组的36.00%、12.00%、14.00%,组间比较差异有统计学意义(P<0.05)。两组下肢麻木发生率两组比较差异均无统计学意义(P>0.05)。结论纳美芬静脉注射辅助剖宫产术后蛛网膜下腔吗啡镇痛可降低术后不良反应发生率,且不影响吗啡镇痛效果。

Objective To observe the effect of intravenous administration of nalmefene on subarachnoid morphine analgesia after cesarean section.Methods From January 2020 to December 2020,100 cases of puerpera undergoing cesarean section under single subarachnoid block in the second hospital of Chaoyang City were selected as the research object.The patients were randomly divided into control group(n=50)and nalmefene group(n=50)by numerical table method.Both groups were given 0.5%bupivacaine(10 mg)and morphine(0.2 mg)mixture after successful subarachnoid puncture.At the end of surgery,the control group did not receive drug intervention;the nalmefene group was given 5 mL intravenous injection of 0.1μg/kg nalmefene.The pain degree was evaluated 3,6,12 and 24 hours after surgery,and the incidence of complications such as nausea,vomiting,pruritus and lower limb numbness in the two groups were recorded.Results There was no significant difference in pain degree at 3,6,12 and 24 hours after cesarean section between the two groups(P>0.05).The incidence of nausea,vomiting and pruritus in nalmefene group was 4.00%,0.00%and 2.00%,respectively,lower than 36.00%,12.00%and 14.00%in the control group,with statistical significance(P<0.05).There was no statistical significance in the incidence of lower limb numbness between the two groups(P>0.05).Conclusion Nalmefene intravenous injection of morphine analgesia in subarachnoid space after cesarean section can reduce the incidence of postoperative adverse reactions,and does not affect the analgesic effect of morphine.