文章摘要
纳布啡不同镇痛泵参数用于剖宫产术后镇痛的比较
Comparison of analgesic pumps with different parameters of nalbuphine for postoperative analgesia after cesarean section
  
DOI：10.12089/jca.2024.03.005
中文关键词: 剖宫产  纳布啡  术后镇痛  患者自控静脉镇痛  参数设置
英文关键词: Cesarean section  Nalbuphine  Postoperative analgesia  Patient-controlled intravenous analgesia  Parameter setting
基金项目:
作者单位E-mail
叶卉 210009,南京市,东南大学附属中大医院麻醉手术与疼痛管理科  
孙杰 210009,南京市,东南大学附属中大医院麻醉手术与疼痛管理科  
汪佳佳 210009,南京市,东南大学附属中大医院麻醉手术与疼痛管理科  
黄露欣 210009,南京市,东南大学附属中大医院麻醉手术与疼痛管理科  
谢珏 210009,南京市,东南大学附属中大医院麻醉手术与疼痛管理科 very_wang@126.com 
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中文摘要:
      
目的：比较三种不同参数纳布啡患者自控静脉镇痛（PCIA）用于剖宫产术后镇痛的效果。
方法：选择剖宫产术后的产妇179例，年龄18～45岁，BMI 20～35 kg/m2，ASA Ⅰ或Ⅱ级，术后均给予PCIA（纳布啡2 mg/kg+托烷司琼8 mg/100 ml，间隔时间15 min，极限量10 ml/h）。将产妇随机分成三组：对照组（C组，背景量2 ml/h，单次按压2 ml，n=60）、低背景量组（L组，背景量1 ml/h，单次按压3 ml，n=62）和无背景量组（N组，背景量0 ml/h，单次按压4 ml，n=57）。记录术后2、6、12、24、48 h静息和活动时VAS疼痛评分、纳布啡消耗量。记录术后48 h内PCIA按压情况、术后首次肛门排气时间、术后住院时间、Ramsay镇静评分和术后恶心呕吐、头晕、感染等不良反应的发生情况。
结果：与C组比较，N组术后6、12 h静息时VAS疼痛评分明显升高（P<0.05），L组和N组术后24、48 h纳布啡消耗量明显减少，术后首次肛门排气时间明显缩短，头晕发生率明显降低（P<0.05），N组术后住院时间明显缩短（P<0.05）。与L组比较，N组术后12 h静息和活动时VAS疼痛评分明显升高，术后48 h纳布啡消耗量明显减少，总按压次数和有效按压次数明显增加，术后首次肛门排气时间明显缩短（P<0.05）。三组Ramsay镇静评分和术后恶心呕吐、感染发生率差异无统计学意义。
结论：低背景量（1 ml/h）纳布啡PCIA可在充分镇痛的同时，减少阿片类药物用量，降低相关不良反应发生率，缩短术后首次肛门排气时间，可作为纳布啡PCIA用于剖宫产术后镇痛参数设置的优先选择。
英文摘要:
      
Objective: To study the effect of patient-controlled intravenous analgesia (PCIA) with nalbuphine under different parameter settings on postoperative analgesia after cesarean section.
Methods: A total of 179 parturients after cesarean section, aged 18-45 years, BMI 20-35 kg/m2, ASA physical status Ⅰ or Ⅱ, were selected to receive PCIA (nalbuphine 2 mg/kg + tropisetron 8 mg/100 ml, 15-minute interval, maximum limit 10 ml/h). The parturients were randomly divided into three groups: control group (group C, receiving continuous infusion rate 2 ml/h and bolus dose 2 ml, n = 60), low background group (group L, receiving continuous infusion rate 1 ml/h and bolus dose 3 ml, n = 62), and no background group (group N, no continuous infusion rate, bolus dose 4 ml, n = 57). VAS scores at rest and active, and nalbuphine consumption were recorded at 2, 6, 12, 24, and 48 hours after operation. The press condition of PCIA within 48 hours after operation, the time of first flatus and postoperative hospital stay, Ramsay sedation scale (RSS) scores, and adverse reactions such as postoperative nausea and vomiting, dizziness, and infection were also recorded.
Results: Compared with group C, VAS pain scores at rest at 6 and 12 hours after operation were significantly decreased in group N (P < 0.05), nalbuphine consumption at 24 and 48 hours after operation was significantly decreased in groups L and N, the time of first flatus and the incidence of dizziness were also significantly reduced in groups L and N (P < 0.05), and the length of postoperative hospital stay was significantly shorter in group N (P < 0.05). Compared with group L, the VAS pain scores at resting and active 12 hours after surgery in group N were significantly increased, the consumption of nalbuphine at 48 hours after surgery was significantly decreased, the total and effective times of compressions were significantly increased, and the first exhaust time was significantly shortened (P < 0.05). There were no significant differences in RSS scores and the incidence of postoperative nausea and vomiting, infection among the three groups.
Conclusion: Nalbuphine PCIA with low background (1 ml/h) provides satisfactory analgesic effect after cesarean section, reduces the dosage of nalbuphine and the incidence of opioid-related adverse reactions and shortens the flatus time, which can be used as the preferred parameter setting for nalbuphine PCIA after cesarean section.
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