不同剂量纳布啡复合舒芬太尼用于剖宫产术后自控静脉镇痛﹑镇静的效果比较

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摘要目的比较不同剂量纳布啡复合舒芬太尼用于剖宫产术后自控静脉镇痛（PCIA）、镇静的效果。方法选取2018年1～12月我院收治的行剖宫产的500例足月产妇作为研究对象，按照随机数字表法将其分为A、B、C、D、E组，每组各100例。手术后产妇采取PCIA 泵药物镇痛：A组给予纳布啡0.5 mg/kg和舒芬太尼0.5 μg/kg；B组给予纳布啡0.5 mg/kg和舒芬太尼1 μg/kg；C组给予纳布啡1 mg/kg和舒芬太尼1μg/kg；D组给予纳布啡1 mg/kg和舒芬太尼1.5 μg/kg；E组给予纳布啡1.5 mg/kg和舒芬太尼1.5 μg/kg。比较五组产妇术后2 h（T1）、4 h（T2）、8 h（T3）、12 h（T4）、24 h（T5）、36 h（T6）、48 h（T7）的视觉模拟量表（VAS）评分、Ramsay 镇静评分（RSS）和镇痛相关不良反应发生情况。结果五组产妇T2、T3、T4、T5 的VAS评分高于本组T1，差异有统计学意义（P＜0.05）；B、C、D、E组产妇各时间点的VAS评分低于A组，C、D、E组产妇各时间点的VAS评分低于B组，D、E组产妇各时间点的VAS评分低于C组，差异均有统计学意义（P＜0.05）；五组产妇T2、T3、T4、T5 的RSS评分低于本组T1，差异有统计学意义（P＜0.05）；B、C、D、E组产妇各时间点的RSS评分高于A组，C、D、E组产妇各时间点的RSS评分高于B组，D、E组产妇各时间点的RSS评分高于C组，差异均有统计学意义（P＜0.05）；E组产妇各时间点的VAS评分和RSS评分与D组产妇比较，差异均无统计学意义（P＞0.05）。C组产妇的术后镇痛相关不良反应总发生率低于A组，差异有统计学意义（P＜0.05）；B、D、E组产妇的术后镇痛相关不良反应总发生率与A组产妇比较，差异无统计学意义（P＞0.05）。结论剖宫产术后PCIA 配方使用纳布啡1 mg/kg和舒芬太尼1 μg/kg 既能产生良好的镇痛、镇静效果，又能减少不良反应的发生。

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	刘金

关键词 ：纳布啡, 舒芬太尼, 剖宫产术, 自控静脉镇痛

Abstract：Objective To compare the effect of different doses of Nalbuphine combined with Sufentanil on patient-controlled intravenous analgesia and sedation after cesarean section.Methods A total of 500 full-term parturients who underwent cesarean section in our hospital from January to December 2018 were selected as the study objects.They were divided into groups A, B, C, D and E according to the method of random number table method, with 100 cases in each group.After the operation, the pregnant women were given PCIA pump drugs for analgesia.Group A was given 0.5 mg/kg of Nalbuphine + 0.5 μg/kg of Sufentanil.Group B was given 0.5 mg/kg of Nalbuphine+1 μg/kg of Sufentanil.Group C was given 1 mg/kg of Nalbuphine+1 μg/kg of Sufentanil.Group D was given 1 mg/kg of Nalbuphine+1.5 μg/kg of Sufentanil.Group E was given 1.5 mg/kg of Nalbuphine + 1.5 μg/kg of Sufentanil.Visual analogue pain scale (VAS)score, Ramsay sedation score (RSS) and adverse reactions related to analgesia were compared at different time points after cesarean section including two hours (T1), four hours (T2), eight hours (T3), 12 hours (T4), 24 hours (T5), 36 hours(T6), 48 hours (T7).Results The VAS scores of T2, T3, T4 and T5 in the five groups were higher than those of T1, and the differences were statistically significant (P＜0.05).The VAS scores of group B, C, D and E at different time points were lower than those of group A, the VAS scores of group C, D and E at different time points were lower than those of group B, and the VAS scores of group D and E at different time points were lower than those of group C, with statistically significant differences (P＜0.05).The RSS scores of T2, T3, T4 and T5 in the five groups were lower than those of T1, the differences were statistically significant (P＜0.05).The RSS scores of group B, C, D and E at different time points were higher than those of group A, the RSS scores of group C, D and E at different time points were higher than those of group B, the RSS scores of group D and E at different time points were higher than those of group C, and the differences were statistically significant (P＜0.05).The VAS scores and RSS scores in group E at different time points were compared with those of the group D, and the differences were not statistically significant (P＞0.05).The total incidence of postoperative analgesia-related adverse reactions in group C was lower than that in group A, and the difference was statistically significant (P＜0.05).The total incidence of postoperative analgesia related adverse reactions in group B, D and E was not statistically significant compared with that in group A (P＞0.05).Conclusion After cesarean section PCIA formula with 1 mg/kg of Nalbuphine and 1 μg/kg of Sufentanil can not only produce good analgesic and sedative effect, but also reduce the occurrence of adverse reactions.

Key words： Nalbuphine Sufentanil Cesarean section Patient controlled intravenous analgesia

作者简介: 刘金（1984-），男，湖北咸宁人，本科，主治医师，研究方向：临床麻醉

引用本文:

刘金. 不同剂量纳布啡复合舒芬太尼用于剖宫产术后自控静脉镇痛﹑镇静的效果比较[J]. 中国当代医药, 2020, 27(23): 133-136.
LIU Jin. Effect comparison of different doses of Nalbuphine combined with Sufentanil on patient-controlled intravenous analgesia and sedation after cesarean section. 中国当代医药, 2020, 27(23): 133-136.

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http://dangdaiyiyao.com/CN/ 或 http://dangdaiyiyao.com/CN/Y2020/V27/I23/133

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