| 黄岩,王丽霞,张莹莹.不同剂量纳布啡联合瑞芬太尼自控镇痛在剖宫产术后的应用.[J].中南医学科学杂志.,2025,(2):276-279. |
| 不同剂量纳布啡联合瑞芬太尼自控镇痛在剖宫产术后的应用 |
| Application of different doses of nalbuphine combined with remifentanil in self-controlled analgesia after cesarean section |
| 投稿时间：2024-07-22 修订日期：2024-11-20 |
| DOI：10.15972/j.cnki.43-1509/r.2025.02.020 |
| 中文关键词: 纳布啡 瑞芬太尼 自控镇痛 剖宫产 [ |
| 英文关键词:nalbuphine remifentanil self-controlled analgesia cesarean section |
| 基金项目:安徽省重点研究与开发计划(202104j07020013) |
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| 中文摘要: |
| 目的探讨不同剂量纳布啡联合瑞芬太尼自控镇痛在剖宫产术后的应用。 方法选择行剖宫产的产妇78例,根据纳布啡剂量均分为低剂量组(1.2 mg/kg)、中剂量组(2.2 mg/kg)和高剂量组(3.2 mg/kg)。各组术后通过自控镇痛分别给予相应剂量纳布啡联合0.3 μg/kg瑞芬太尼。观察各组给药1 h和给药12 h后镇痛效果[视觉模拟评分(VAS)]和镇静效果(Ramsay评分)。比较各组术前、给药1 h和给药6 h时心率(HR)、平均动脉压(MAP)以及术前和给药1 h后血清泌乳素(PRL)、血浆皮质醇(Cor)水平。统计各组治疗过程中不良反应的发生情况。 结果给药12 h后,高剂量组、中剂量组和低剂量组VAS评分依次升高(P＜0.05),Ramsay评分依次降低(P＜0.05)。给药1 h后各组血清PRL均高于术前,中剂量组高于低剂量组和高剂量组(P＜0.05)；而各组血浆Cor均低于术前,中剂量组低于低剂量组和高剂量组(P＜0.05)。低剂量组、高剂量组HR、MAP水平随着时间递增而升高(P＜0.05)；给药6 h后,中剂量组HR、MAP水平低于低剂量组和高剂量组(P＜0.05),低剂量组低于高剂量组(P＜0.05)。高剂量组不良反应发生率高于低剂量组和中剂量组(P＜0.05)。 结论2.2 mg/kg纳布啡联合瑞芬太尼在剖宫产术后镇静镇痛效果最好,能够维持血流动力学稳定,抑制应激反应,并降低不良反应发生率,是一种安全有效的剖宫产术后镇痛方案。 |
| 英文摘要: |
| AimTo study the use of different doses of nalbuphine combined with remifentanil for self-controlled analgesia after cesarean section. MethodsTotally 78 postpartum women who underwent cesarean section in our hospital were divided into low-dose (1.2 mg/kg), medium-dose (2.2 mg/kg), and high-dose groups (3.2 mg/kg) based on the use of different doses of nalbuphine. After surgery, each group was given corresponding doses of nalbuphine combined with 0.3 μg/kg remifentanil. The analgesic effect (Visual Analog Scale (VAS) and sedative effect (Ramsay score) of each group were observed after 1 hour and 12 hours of administration. The heart rate (HR), mean arterial pressure (MAP), prolactin (PRL), and plasma cortisol (Cor) levels of each group before surgery, 1 hour after administration, and 6 hours after administration were compared. The occurrence of adverse reactions during the treatment process was recorded. ResultsAfter 12 h of administration, VAS scores in the high-dose group, medium-dose group, and low-dose group increased sequentially (P＜0.05), while Ramsay scores decreased sequentially (P＜0.05). After 1 h of administration, the serum PRL levels in all groups were higher than the levels before surgery, and the medium-dose group was higher than the low-dose group and high-dose group (P＜0.05); the plasma Cor levels in all groups were lower than the levels before surgery, with the medium-dose group being lower than the low-dose and high-dose groups (P＜0.05). The HR and MAP levels in the low-dose and high-dose groups increased with time (P＜0.05); After 6 h of administration, the HR and MAP levels in the medium dose group were lower than those in the low-dose and high-dose groups (P＜0.05), and the low-dose group was lower than the high-dose group (P＜0.05). The incidence of adverse reactions in the high-dose group was higher than that in the low-dose and medium dose groups (P＜0.05). ConclusionWhen the dose of nalbuphine is 2.2 mg/kg, the combination of remifentanil has the best sedative and analgesic effect after cesarean section, which can maintain hemodynamic stability, inhibit stress response, and reduce the incidence of adverse reactions. It is a safe and effective postoperative analgesia plan for cesarean section. |
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