纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性

Efficacy and safety of nalbuphine for dural puncture epidural labor analgesia

目的探讨纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性。方法选择经阴试产的足月单胎初产妇319例,按使用药物不同分为舒芬太尼硬脊膜穿破硬膜外阻滞组(A组)160例,纳布啡硬脊膜穿破硬膜外阻滞组(B组)159例。两组均采用硬脊膜穿破硬膜外阻滞分娩镇痛法,置入硬膜外导管后,注入1.5%利多卡因3 mL试验量,然后A组注入0.5 mg/L舒芬太尼复合1 mg/L罗哌卡因混合液,B组注入0.3 g/L纳布啡复合1 mg/L罗哌卡因混合液,均6~15 mL为首次量,30 min后两组均连接电子镇痛泵,分别使用舒芬太尼和纳布啡进行自控硬膜外镇痛。收集两组患者的如下指标:镇痛起效时间、首次自控按压镇痛(PCA)时间、PCA有效按压次数、罗哌卡因用量;镇痛前(T0)、镇痛后30 min(T1)、宫口开全(T2)与用力分娩(T3)时疼痛视觉模拟(VAS)评分及Ramsay镇静评分;产妇发热、恶心呕吐、皮肤瘙痒、术后头痛发生等不良反应情况以及胎儿胎心减速发生率、新生儿1 min Apgar评分≤7分发生率、脐动脉血气分析,新生儿神经与适应能力评分。结果与A组比较,B组恶心呕吐、皮肤瘙痒、胎心减速及新生儿1 min Apgar评分≤7分的发生率显著降低(χ^(2)=4.159~5.628,P<0.05),PCA有效按压次数、罗哌卡因用量显著增加(χ^(2)=8.594、6.363,P<0.05),T2及T3产妇VAS评分明显升高(F=45.314、26.717,P<0.05),其他观察指标两组间比较差异无统计学意义(P>0.05)。结论纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛与舒芬太尼相比第一产程镇痛效果类似,第二产程效果较差,但可降低产妇镇痛相关不良反应发生率,对新生儿具有较高的安全性。

Objective To investigate the efficacy and safety of nalbuphine for dural puncture epidural labor analgesia.[WTHX]Methods A total of 319 primiparous women with a full-term single fetus who received trial of labor were enrolled,and according to the drug used for analgesia,they were divided into sufentanil group(group A with 160 women)and nalbuphine group(group B with 159 women).The women in both groups were given dural puncture epidural labor analgesia,during which 3 mL of 1.5%lidocaine was injected after epidural catheter placement,and then the women in group A were given injection of 0.5 mg/L sufentanil combined with 1 mg/L ropivacaine,while those in group B were given injection of 0.3 g/L nalbuphine combined with 1 mg/L ropi-vacaine,with an initial volume of 6-15 mL.After 30 minutes,an electronic analgesia pump was connected for both groups,and sufentanil and nalbuphine were used for patient-controlled epidural analgesia,respectively.The following indicators were collected and observed:Onset time of analgesia,time of first patient-controlled analgesia(PCA)pressing,number of effective PCA pres-sings,and amount of ropivacaine used;Visual Analogue Scale(VAS)score and Ramsay sedation score before analgesia(T0),at 30 minutes after analgesia(T1),at the time of uterine opening(T2),and during labor(T3);incidence rates of adverse reactions in parturients,including pyrexia,nausea and vomiting,skin pruritus,and postoperative headache;the incidence rate of fetal heart rate deceleration,the proportion of neonates with 1 min Apgar score≤7 points,umbilical arterial blood gas analysis,and neonatal neurological and adaptive capacity scores.Results Compared with group A,group B had significant reductions in the incidence rates of vomiting and nausea,skin pruritus,fetal heart rate deceleration,and neonatal 1 min Apgar score≤7(χ^(2)=4.159-5.628,P<0.05)and significant increases in the number of effective PCA pressings and the amount of ropivacaine used(χ^(2)=8.594,6.363,P<0.05),as well as a significant increase in VAS score of the parturients at T2 and T3(F=45.314,26.717,P<0.05),while there were no significant differences in the other indicators between the two groups(P>0.05).Conclusion For dural puncture epidural labor analgesia,nalbuphine has a similar analgesic effect to sufentanil in the first stage of labor,with a poorer effect in the second stage of labor,but it can reduce analgesia-related adverse reactions in parturients and has a relatively favorable safety profile[HJ1.8mm]in neonates.