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| 纳布啡治疗产妇腰-硬联合麻醉后寒战的临床效果 |
| Clinical investigation of nalbuphine for treatment of post combined spinal-epidural anesthesia shivering in patients undergoing cesarean section |
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| DOI：10.12089/jca.2018.02.007 |
| 中文关键词: 纳布啡 腰-硬联合麻醉 寒战 剖宫产 |
| 英文关键词: Nalbuphine Combined spinal-epidural anesthesia Shivering Cesarean section |
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| 中文摘要: |
| 目的 观察纳布啡治疗产妇腰-硬联合麻醉后寒战的临床效果及不良反应。方法 选择择期腰-硬联合麻醉下行子宫下段剖宫产术,术中发生寒战Wrench 3/4级的产妇90例,年龄20～35岁,ASA Ⅰ或Ⅱ级。于寒战发生后随机双盲分为三组,每组30例,立即静脉注射生理盐水(C组)、纳布啡0.07 mg/kg(N组)和曲马多1 mg/kg(T组)。记录麻醉结束至寒战开始时间、药物处理后寒战消失时间、寒战治疗成功和复发的情况、改良OAA/S镇静评分,以及恶心呕吐、心动过缓、低血压等不良反应的发生情况。结果 三组麻醉结束至寒战开始时间差异无统计学意义。N组和T组药物处理后寒战消失时间分别为(3.6±1.3)min和(4.2±2.2)min,明显短于C组的(14.3±7.3)min(P＜0.05)。N组和T组寒战治疗成功率分别为93.3%和90.0%,明显高于C组的16.7%(P＜0.05);复发率分别为7.1%和11.1%,明显低于C组的80.0%(P＜0.05)。N组OAA/S镇静评分明显高于C、T组(P＜0.05)。T组恶心呕吐发生率60.0%,明显高于C组和N组的20.0%和13.3%(P＜0.05);三组心动过缓、低血压发生率差异无统计学意义。结论 纳布啡0.07 mg/kg可安全有效地治疗腰-硬联合麻醉产妇发生的寒战,且不良反应恶心呕吐的发生率较曲马多更低,具备可接受的镇静作用。 |
| 英文摘要: |
| Objective To investigate the clinical efficacy and side effects of nalbuphine for treatment of post combined spinal-epidural anesthesia shivering undergoing cesarean section. Methods Ninety puerpera underwent elective caesarean section under combined spinal-epidural anesthesia, who developed shivering Wrench grade 3 or 4, aged 20-35 years, ASA physical status Ⅰ or Ⅱ, were randomly and double-blindly divided into three groups with 30 puerpera each to receive either saline (group C) or nalbuphine (group N, 0.07 mg/kg) or tramadol (group T, 1 mg/kg) as a slow intravenous bolus for treatment of shivering. Onset of shivering, time interval from treatment to cessation of shivering, success rate, recurrence rate after successon treatment outcome of shivering, OAA/S sedation scores, nausea and vomiting, bradycardia and hypotension were recorded. Results There was no significant difference of the time interval from treatment to cessation of shivering between the three groups. Compared with group C, there was statistically significant shorter time interval from treatment to cessation of shiveringin group N ［(3.6±1.3) min vs (14.3±7.3) min］ and group T ［(4.2±2.2) min vs (14.3±7.3) min］, higher success ratein group N (93.3% vs 16.7%) and group T (90% vs 16.7%) and lower recurrance ratein group N (7.1% vs 80.0%) and group T (11.1% vs 80.0%)(P＜0.05). Higher sedation scores in group N were observed (P＜0.05). The incidence of nausea and vomiting was 60.0% in group T, which was significantly higher than those in group C (20.0%) and group N (13.3%) (P＜0.05). There was no significant difference in the incidence of bradycardia and hypotension in three groups. Conclusion Nalbuphine can control the shivering of post combined spinal-epidural anesthesia undergoing cesarean section safely and effectively, which seems suitable for parturients cesarean delivery due to the lower incidence of nause and vomiting and a certain sedation effect. |
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