纳布啡联合高平面腰麻对剖宫产术中牵拉反应的影响

Effect of Nalbuphine Combined with High-plane Lumbar Anesthesia after on Traction Reaction during Caesarean Section

目的:观察纳布啡联合高平面腰麻对剖宫产术中牵拉反应的防治效果。方法:选取2022年6月—2023年12月新余市人民医院收治的100例行剖宫产手术的产妇作为研究对象。随机将产妇分为纳布啡组和盐水组,各50例。所有产妇均在腰麻下完成手术,并控制麻醉平面在胸4水平。在胎儿娩出断脐后5 min,纳布啡组静脉缓慢注射0.2 mg/kg纳布啡,盐水组静脉注射相同剂量的生理盐水。观察两组给药前(T_(1))、给药后10 min(T_(2))、腹腔清洗时(T_(3))、手术结束时(T_(4))的心率(HR)、平均动脉压(MAP)、呼吸频率(RR),比较两组术中血氧饱和度(SpO_(2))、Ramsay镇静评分及术中牵拉反应发生情况。结果:T_(2),纳布啡组RR均低于T_(1)、T_(3)及盐水组,差异均有统计学意义(P<0.05);T_(3),盐水组HR均高于T_(1)、T_(4),差异均有统计学意义(P<0.05)。两组术中SpO_(2)正常患者占比比较,差异无统计学意义(P>0.05);纳布啡组Ramsay镇静评分明显高于盐水组,差异有统计学意义(P<0.05)。纳布啡组术中牵拉反应发生率低于盐水组,差异有统计学意义(P<0.05)。结论:纳布啡联合高平面腰麻可有效抑制剖宫产术中牵拉反应,对呼吸无明显影响,术中镇静良好,是一种能够有效防治剖宫产术中牵拉反应的方案。

Objective:To investigate the effect of Nalbuphine combined with high-plane lumbar anesthesia on traction reaction during caesarean section.Method:A total of 100 parturients who underwent cesarean section in Xinyu People's Hospital from June 2022 to December 2023 were selected as the research objects.The parturients were randomly divided into Nalbuphine group and saline group,with 50 cases in each group.All parturients underwent surgery under lumbar anesthesia and controlled the anesthesia plane at chest 4 level.At 5 minutes after the fetal umbilical cord was severed,the Nalbuphine group was slowly injected intravenously with 0.2 mg/kg of Nalbuphine,and the saline group was injected intravenously with the same dose of normal saline.The heart rate(HR),mean arterial pressure(MAP)and respiratory rate(RR)of the two groups were observed before administration(T_(1)),10 min after administration(T_(2)),during abdominal cleansing(T_(3)),and at the end of operation(T_(4));blood oxygen saturation(SpO_(2)),Ramsay sedation score and intraoperative traction reaction were compared between the two groups.Result:T_(2),the RR of the Nalbuphine group was lower than that of the T_(1),T_(3) and saline group,the differences were statistically significant(P<0.05).T_(3),the HR of the saline group was higher than that of T_(1) and T_(4),the differences were statistically significant(P<0.05).There was no statistically significant difference in the proportion of SpO_(2) normal patients between the two groups during surgery(P>0.05).The Ramsay sedation score in the Nalbuphine group was significantly higher than that in the saline group,the difference was statistically significant(P<0.05).The incidence of intraoperative traction reaction in the Nalbuphine group was lower than that in the saline group,the difference was statistically significant(P<0.05).Conclusion:Nalbuphine combined with high-plane lumbar anesthesia can effectively inhibit the traction reaction during cesarean section,and has no obvious effect on respiration,and good sedation during the operation,which is an effective plan to prevent and treat the traction reaction during cesarean section.