不同剂量盐酸纳布啡联合舒芬太尼用于连续硬膜外麻醉在瘢痕子宫剖宫产术后的静脉镇痛效果比较

Comparison the effect of different doses of naborphine hydrochloride combined with sufentanil in continuous epidural anesthesia for postoperative intravenous analgesia in cesarean section of scarred uterus

目的分析不同剂量盐酸纳布啡联合舒芬太尼用于连续硬膜外麻醉在瘢痕子宫剖宫产术后静脉镇痛的效果。方法选取2021年7—12月兴化市妇幼保健院收治的120例行连续硬膜外麻醉瘢痕子宫剖宫产的产妇作为研究对象,依据术后静脉镇痛剂量分为A组、B组与C组,各40例。A组给予2μg/kg舒芬太尼麻醉,B组给予1.5 mg/kg盐酸纳布啡联合0.5μg/kg舒芬太尼麻醉,C组给予1.0 mg/kg盐酸纳布啡联合1.5μg/kg舒芬太尼麻醉。比较3组镇痛效果、24 h内静脉自控镇痛(PCIA)有效按压次数、血流动力学(平均动脉压、心率)与不良反应发生情况。结果C组Ramsay镇静评分高于B组、A组,且B组高于A组,差异有统计学意义(P<0.05);C组24 h内PCIA有效按压次数少于A组、B组,且B组少于A组,差异有统计学意义(P<0.05)。3组平均动脉压与心率组间、时间、交互比较差异有统计学意义(P<0.05)。术后6、12 h,C组平均动脉压、心率均低于A组、B组,差异有统计学意义(P<0.05);其他组间两两比较差异无统计学意义。3组不良反应发生率比较差异有统计学意义(P<0.05);C组不良反应发生率低于A组、B组,差异有统计学意义(P<0.05);A组与B组不良反应发生率比较差异无统计学意义。结论盐酸纳布啡联合舒芬太尼在剖宫产术后的镇痛效果显著,最佳剂量为1.0 mg/kg纳布啡联合1.5μg/kg舒芬太尼,可有效稳定患者血流动力学,减少不良反应发生,值得临床推广。

Objective To analyze the effect of different doses of naborphine hydrochloride combined with sufentanil in continuous epidural anesthesia for postoperative intravenous analgesia in cesarean section of scarred uterus.Methods A total of 120 cases of cesarean section with scar uterus under continuous epidural anesthesia in Xinghua Maternal and Child Health Hospital from July to December 2021 were selected as the research subjects,they were divided into groups A,group B and group C according to the postoperative intravenous analgesia dose,with 40 cases in each group.The group A was treated with 2μg/kg sufentanil,group B was treated with 1.5 mg/kg naborphine+0.5μg/kg sufentanil,and group C was treated with 1.0 mg/kg naborphine+1.5μg/kg sufentanil.The analgesic effect,effective pressing times of PCIA within 24 h,hemodynamics(mean arterial pressure,heart rate)and adverse reactions were compared among the three groups.Results The Ramsay sedative score in the group C was higher than that in the group B and the group A,and group B was lower than group A,and the differences were satistically significant(P<0.05).The effective pressing times of PCIA within 24 h in the group C was lower than that in the group B and the group A,and the group B was lower than the group A,and the differences were satistically significant(P<0.05).There were significant differences in mean artery pressure and heart rate of among the three groups of group,time and interaction(P<0.05).6,12 h after surgery,the mean arterial pressure and heart rate in the group C were lower than the group B and the group A,and the differences were satistically significant(P<0.05);there were no significant differences between the other groups.There was significant difference in the incidence of adverse reactions among the three groups(P<0.05);the incidence of adverse reactions in the group C was lower than that in the group A and the group C,and the differences were satistically significant(P<0.05),there was no significant difference in the incidence of adverse reactions between the group A and group B.Conclusion Nalbuphine hydrochloride combined with sufentanil has significant analgesic effect after cesarean section,the best dose is 1.0 mg/kg nalbuphine+1.5μg/kg sufentanil can effectively stabilize the hemodynamics of patients and reduce the incidence of adverse reactions,which is worthy of clinical promotion and application.