不同剂量纳布啡预防剖宫产产妇术中寒战的效果比较

Optimal dose of Nalbuphine in combined lumbar-epidural anesthesia for cesarean section and its effects on maternal chills

目的:比较不同剂量纳布啡预防剖宫产产妇术中寒战的效果。方法:选取2019年8月至2020年6月于该院行腰-硬联合麻醉剖宫产产妇105例进行前瞻性研究,按照随机数字表法分为A、B、C三组各35例。胎儿娩出即刻,A、B、C三组依次静脉注射纳布啡0.10、0.15、0.20 mg/kg,比较三组给药前、给药后10 min、术毕时镇静状况[警觉/镇静观察(OAA/S)]评分,术后2、6、12 h时视觉模拟评分法(VAS)评分,术中寒战发生情况以及不良反应发生率。结果:给药后10 min、术毕时,B、C组OAA/S评分均低于A组,差异有统计学意义(P<0.05),但B、C组OAA/S评分比较,差异无统计学意义(P>0.05);术后2、6、12 h,B、C组VAS评分均低于A组,差异有统计学意义(P<0.05),但B、C组VAS评分比较,差异无统计学意义(P>0.05);B、C组术中寒战分级优于A组,差异有统计学意义(P<0.05),但B、C组寒战分级比较,差异无统计学意义(P>0.05);A、B组不良反应发生率均为2.86%(1/35),低于C组的22.86%(8/35),差异有统计学意义(P<0.05)。结论:剖宫产腰-硬联合麻醉中应用纳布啡的最适剂量为0.15 mg/kg,有利于预防产妇术中发生寒战,且安全性良好。

Objective:To explore optimal dose of Nalbuphine in combined lumbar-epidural anesthesia for cesarean section and its effects on maternal chills.Methods:A prospective study was performed on 105 women undergoing cesarean section under combined spinal-epidural anesthesia in this hospital from August 2019 to June 2020,and they were divided into groups A,B,and C according to the random number table method,35cases in each.Immediately after the fetus was delivered and the umbilical cord was clipped,groups A,B,and C were given intravenous injection of Nalbuphine 0.10,0.15,and 0.20 mg/kg.The scores of sedation status [observer’s assessment of alertness/sedation(OAA/S)] before administration,10minutes after administration,and at the end of the surgery,the visual analogue scale(VAS) scores 2,6,and 12 hours after the surgery,the occurrence of chills,and the incidence of adverse reactions were compared among the three groups.Results:10 minutes after administration and at the end of the surgery,the OAA/S scores of groups B and C were lower than that of group A,and the differences were statistically significant(P<0.05);however,there was no statistical difference in the OAA/S score between groups B and C(P>0.05).2,6,and 12 hours after the surgery,the VAS scores of groups B and C were lower than that of group A,and the differences were statistically significant(P<0.05);however,there was no significant difference in the VAS score between groups B and C(P>0.05).The intraoperative chill grades in groups B and C were better than that in group A,and the differences were statistically significant(P<0.05).Further,the incidence of adverse reactions in groups A and B was 2.86%(1/35),which was lower than 22.86%(8/35) in group C,and the differences were statistically significant(P<0.05).Conclusions:The optimal dose of Nalbuphine in combined spinal-epidural anesthesia for cesarean section is 0.15 mg/kg,which is beneficial to improve the maternal chills grading and has good safety.