纳布啡联合右美托咪定对剖宫产术后镇痛及泌乳影响的观察

目的观察纳布啡联合右美托咪定对剖宫产的术后镇痛效果及泌乳的影响。方法本研究为单盲、随机、对照试验。收集西安航天总医院2017年5月至2019年5月在腰硬联合麻醉(CSEA)下择期剖宫产术产妇90例,随机分为纳布啡联合右美托咪定组(ND组)、纳布啡组(N组)及舒芬太尼组(S组),每组各30例。三组术后接电子镇痛泵实施患者自控静脉镇痛(PCIA)。分别记录术后6h、24h、48h的VAS疼痛评分和Ramsay镇静评分;术后48h内PCIA按压总次数、有效按压次数和镇痛失败补救情况;镇痛不良反应和镇痛满意度;记录术前、术后24h、术后48h血清泌乳素浓度和初次泌乳时间,并进行统计分析。结果三组术后6h、24h、48h切口痛VAS评分比较差异均有统计学意义(F值分别为19.031、20.491、12.900,均P<0.05)。三组术后6h、24h、48h宫缩痛VAS评分比较差异均有统计学意义(F值分别为17.222、35.582、14.934,均P<0.05)。三组术后6h、24h的Ramsay镇静评分比较差异均有统计学意义(F值分别为3.965、11.840,均P<0.05),而术后48h的Ramsay镇静评分比较差异无统计学意义(P>0.05)。三组术后48h内的PCIA按压总次数、有效按压次数比较差异均有统计学意义(F值分别为3.874、5.430,均P<0.05)。三组产妇术前、术后24h、术后48h的血清泌乳素(PRL)含量、初次泌乳时间比较差异均无统计学意义(均P>0.05)。三组术后恶心、呕吐发生率比较差异均有统计学意义(P值分别为0.035、0.044)。ND组术后镇痛满意率高于S组,差异有统计学意义(χ^2=6.648,P<0.05);ND组与N组、N组与S组术后镇痛满意率比较差异均无统计学意义(均P>0.05)。结论纳布啡联合右美托咪定具有较好的镇痛、镇静作用,不良反应发生率较低,产妇术后镇痛满意度高,对产妇PRL分泌和泌乳时间均无显著影响。

Observation of analgesic effect and influence on lactation of PCIA with nalbuphine combined with dexmedetomidine after cesarean section

Objective To observe analgesic effect and influence on lactation of the patient controlled intravenous anesthesia(PCIA)with nalbuphine combined with dexmedetomidine after cesarean section.Methods A single-blind,randomized,controlled trial was conducted.90 parturients who were scheduled for cesarean delivery under combined spinal-epidural anesthesia(CSEA)in Xi’an Aerospace General Hospital from May 2017 to May 2019 were enrolled in this study.The patients were randomly divided into nalbuphine combined with dexmedetomidine group(ND group),nalbuphine alone group(N group)and Sufentanil alone group(S group)(n=30 in each group).All patients employed PCIA electronic analgesic pump after surgery.The VAS pain score and Ramsay sedation score were recorded at 6 h,24 h and 48 h after operation;total frequency of PCIA pressing,effective pressing frequency and failure to remedy pain were recorded within 48 h after operation;adverse reactions of analgesics and satisfaction for analgesia were recorded as well.Plasma prolactin concentration before operation,at 24 h and 48 h after operation and initial lactation time were recorded at the same time.Results The VAS score in incision pain of the patients in ND group was lower than that of the patients in N group and S group at 6 h,24 h and 48 h after operation and the differences were significant(F=19.031,20.491 and 12.900 respectively,all P<0.05);the VAS score in uterine contraction pain in ND group and N group were lower than that in S group at 6 h,24 h,48 h after operation(F=17.222,35.582 and 14.934 respectively,all P<0.05).The Ramsay sedation score in ND group was higher than that in S group at 6 h and 24 h after operation and the differences were significant(F=3.965 and 11.840 respectively,both P<0.05),while the difference at 48 h was not significant(P>0.05);the total frequency of PCIA pressing and effective pressing frequency in ND group were lower than those in N group and S group at 48 h after operation(F=3.874 and 5.430 respectively,both P<0.05).There were no significant differences in serum prolactin(PRL)levels and initial lactation time among three groups before surgery,at 24 h and 48 h after operation(all P>0.05).The incidences of nausea and vomiting in ND group were lower than those in N group and S group(P=0.035 and 0.044).The rate of satisfaction for postoperative analgesia of the patients in ND group was higher than that in S group(χ^2=6.648,P<0.05).While there were no significant differences in satisfaction degree between ND group and N group and between N group and S group(both P>0.05).Conclusion Nalbuphine combined with dexmedetomidine has better analgesic and sedative effects,lower incidence of adverse reactions,higher satisfaction for postoperative analgesia,and has no significant effect on serum PRL secretion and initial lactation time of the parturients.