精准医学杂志2024，Vol.39Issue(5)：444-447,451,5.DOI:10.13362/j.jpmed.202405016
纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性
Efficacy and safety of nalbuphine for dural puncture epidural labor analgesia
摘要
Abstract
Objective To investigate the efficacy and safety of nalbuphine for dural puncture epidural labor analgesia.Methods A total of 319 primiparous women with a full-term single fetus who received trial of labor were enrolled,and according to the drug used for analgesia,they were divided into sufentanil group(group A with 160 women)and nalbuphine group(group B with 159 women).The women in both groups were given dural puncture epidural labor analgesia,during which 3 mL of 1.5％lido-caine was injected after epidural catheter placement,and then the women in group A were given injection of 0.5 mg/L sufentanil combined with 1 mg/L ropivacaine,while those in group B were given injection of 0.3 g/L nalbuphine combined with 1 mg/L ropi-vacaine,with an initial volume of 6-15 mL.After 30 minutes,an electronic analgesia pump was connected for both groups,and sufentanil and nalbuphine were used for patient-controlled epidural analgesia,respectively.The following indicators were collected and observed:Onset time of analgesia,time of first patient-controlled analgesia(PCA)pressing,number of effective PCA pres-sings,and amount of ropivacaine used;Visual Analogue Scale(VAS)score and Ramsay sedation score before analgesia(T0),at 30 minutes after analgesia(T1),at the time of uterine opening(T2),and during labor(T3);incidence rates of adverse reactions in parturients,including pyrexia,nausea and vomiting,skin pruritus,and postoperative headache;the incidence rate of fetal heart rate deceleration,the proportion of neonates with 1 min Apgar score ≤7 points,umbilical arterial blood gas analysis,and neonatal neurological and adaptive capacity scores.Results Compared with group A,group B had significant reductions in the incidence rates of vomiting and nausea,skin pruritus,fetal heart rate deceleration,and neonatal 1 min Apgar score ≤7(x2=4.159-5.628,P＜0.05)and significant increases in the number of effective PCA pressings and the amount of ropivacaine used(x2=8.594,6.363,P＜0.05),as well as a significant increase in VAS score of the parturients at T2 and T3(F=45.314,26.717,P＜0.05),while there were no significant differences in the other indicators between the two groups(P＞0.05).Conclusion For dural puncture epidural labor analgesia,nalbuphine has a similar analgesic effect to sufentanil in the first stage of labor,with a poorer effect in the second stage of labor,but it can reduce analgesia-related adverse reactions in parturients and has a relatively favorable safety profile in neonates.关键词
纳布啡/舒芬太尼/镇痛,产科/镇痛,硬膜外/脊椎穿刺/麻醉,产科/疗效比较研究Key words
Nalbuphine/Sufentanil/Analgesia,obstetri-cal/Analgesia,epidural/Spinal puncture/Anesthesia,obstetrical/Comparative effectiveness research分类
医药卫生引用本文复制引用
李晓征,王雪梅,李井柱,于文刚,毕燕琳,陶红..纳布啡用于硬脊膜穿破硬膜外阻滞分娩镇痛的有效性及安全性[J].精准医学杂志,2024,39(5):444-447,451,5.基金项目
青岛市卫健委医药科研指导计划项目(2015-WJZD009) （2015-WJZD009）
