文章摘要
不同剂量纳布啡对腰-硬联合麻醉剖宫产产妇寒战的影响
Efficacy of different doses of nalbuphine for prevention of shivering after combined spinal-epidural anesthesia in patients undergoing caesarean section
  
DOI：10.12089/jca.2021.01.010
中文关键词: 纳布啡  寒战  剖宫产术  腰-硬联合麻醉
英文关键词: Nalbuphine  Shivering  Cesarean section  Combined spinal-epidural anesthesia
基金项目:
作者单位E-mail
岳晓敏 030032,太原市,山西白求恩医院,山西医学科学院麻醉科  
贺建东 030032,太原市,山西白求恩医院,山西医学科学院麻醉科  
王晓鹏 030032,太原市,山西白求恩医院,山西医学科学院麻醉科  
姜先红 030032,太原市,山西白求恩医院,山西医学科学院麻醉科  
韩冲芳 030032,太原市,山西白求恩医院,山西医学科学院麻醉科 115612291@qq.com 
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中文摘要:
      
目的 比较不同剂量纳布啡用于预防腰-硬联合麻醉剖宫产产妇寒战的效果及不良反应。
方法 选择拟在腰-硬联合麻醉下行择期剖宫产单胎、足月妊娠产妇150例，年龄20～35岁，体重50～80 kg，ASA Ⅰ或Ⅱ级。采用随机双盲法将产妇随机分为五组：对照组（C组）、N1组、N2组、N3组和N4组，每组30例。胎儿娩出后夹毕脐带即刻，N1组、N2组、N3组和N4组产妇分别静注纳布啡0.05和0.1、0.15和0.2 mg/kg，C组静注等容量生理盐水。采用Wrench寒战分级评价给药后至手术结束时寒战的发生情况，记录给药前和给药后30 min的Ramsay镇静评分，记录给药后至手术结束时过度镇静、恶心呕吐、低血压、心动过缓、口干、多汗、眩晕及牵拉反应的发生情况。
结果 与C组和N1组比较，N2组、N3组和N4组寒战发生率明显降低，牵拉反应明显减少（P<0.05）。与给药前比较，N2组、N3组和N4组给药后30 min Ramsay镇静评分均明显升高（P<0.05）。与N4组比较，C组、N1组、N2组和N3组眩晕、口干、多汗发生率明显降低（P<0.05）。
结论 纳布啡0.1 mg/kg和0.15 mg/kg可安全有效地用于预防腰-硬联合麻醉剖宫产产妇寒战的发生。
英文摘要:
      
Objective To compare the efficacy and adverse reactions of different doses of nalbuphine in preventing shivering after combined spinal-epidural anesthesia in patients undergoing caesarean section.
Methods A total of 150 patients, aged 20-35 years, weighing 50-80 kg, ASA physical statusⅠ or Ⅱ, were randomly and double-blindly divided into 5 groups (n = 30 in each group): control group (group C) and nalbuphine groups (groups N1, N2, N3, and N4). After delivery, the patients in groups N1, N2, N3, and N4 were received an intravenous infusion dose of 0.05, 0.1, 0.15, and 0.2 mg/kg nalbuphine immediately before clamping the umbilical cord, and the equal volume of normal saline was given instead in group C. The development of shivering was recorded from the end of nalbuphine administration to the end of surgery, and the shivering intensity was estimated using Wrench grading. Ramsay sedation score was recorded 30 minutes before giving nalbuphine and 30 minutes after giving nalbuphine.The incidences of over-sedation, nausea and vomiting, hypotension, bradycardia, xerostomia, hyperhidrosis, vertigo, and traction reaction were recorded from the end of nalbuphine administration to the end of surgery.
Results Compared with group C and group N1, the incidence of shivering and traction reaction were decreased in groups N2, N3, and N4 (P < 0.05). Compared with before giving nalbuphine, the Ramsay sedation scores were significantly increased at 30 minutes after giving nalbuphine in groups N2, N3, and N4 (P < 0.05). Compared with group N4, the incidence of vertigo, xerostomia, and hyperhidrosis was decreased than that in groups C, N1, N2, and N3 (P < 0.05).
Conclusion Nalbuphine 0.1 and 0.15 mg/kg can prevent shivering after combined spinal-epidural anesthesia in patients undergoing cesarean section safely and effectively.
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