静脉输注纳布啡与瑞芬太尼辅佐硬膜外分娩镇痛的效果比较

目的:比较静脉输注纳布啡与瑞芬太尼辅佐硬膜外阻滞应用于分娩镇痛的临床效果和安全性。方法:选择2020年8月至10月广州医科大学附属第三医院足月初产妇150例，按照简单随机数字表法分为单纯硬膜外镇痛组（C组）、纳布啡辅佐硬膜外镇痛组（N组）和瑞芬太尼辅佐硬膜外镇痛组（R组），每组50例。3组均待宫口开至3 cm时行硬膜外...

Adjuvant intravenous infusion of nalbuphine versus remifentanil in epidural labor analgesia

Objective　To compare the clinical efficacies and safety of intravenous nalbuphineand remifentanil combined with epidural block in labor analgesia. Methods　A total of 150 full-term puerperae at ThirdAffiliated Hospital of Guangzhou Medical University from August to October 2020were randomly divided into a simple epidural analgesia group (group C), analbuphine adjuvant epidural analgesia group (group N), and a remifentaniladjuvant epidural analgesia group (group R), with 50 cases in each group. Allthe three groups received epidural labor analgesia when their uterine orificeswere opened to 3 cm. Within 10 minutes before the epidural puncture, group Nwas given intravenous injection of nalbuphine 0.1 mg/kg, and group R was givenintravenous injection of remifentanil 0.20 μg/kg, then continuous intravenousinfusion of remifentanil 0.05 μg/kg·min^-1 until the anesthesia levelreached T10 and the infusion was stopped. All the three groups was given 0.065%ropivacaine + 0.4 μg/ml sufentanil epidural continuous infusion. The scores ofVisual Analogue Scale (VAS) were recorded before analgesia, at epiduralpuncture, and each time point after analgesia. The duration of labor, the rateof cesarean section, the rate of instrumental-assisted labor, the utilizationrate of oxytocin, and the maternal satisfaction were recorded. The neonates'Apgar scores (1, 5, and 10 min) were recorded, and their umbilical artery bloodwas extracted for blood gas analysis. The adverse reactions during deliverywere observed. The independent-sample t,paired t, and χ² tests were applied. Results　The VAS scores at epidural puncture in group N and group R weresignificantly lower than that in group C [(5.68±1.13) and (5.61±1.11) vs.(8.10±1.00)], with statistical differences between group N and group C andbetween group R and group C (both P<0.05)but no between group N and group R (P>0.05).The scores of maternal satisfaction in group N and group R were higher thanthat in group C [(9.04±0.86) and (9.36±0.74) vs. (8.47±0.84)], with statisticaldifferences between group N and group C and between group R and group C (both P<0.05) but no between group N andgroup R (P>0.05). The Ramsaysedation scores at epidural puncture in group N and group R was higher thanthat in group C [(1.75±0.43) and (2.17±0.60) vs. (1.17±0.38)], with statisticaldifferences (both P<0.05). Theincidences of dizziness in group N and group R were higher than that in group C[32% (16/50) and 40% (20/50) vs. 12% (6/50)], with statistical differencesbetween group N and group C and between group R and group C (both P<0.05) but no between group N andgroup R (P>0.05). The incidence ofnarcolepsy in group R was 10% (5/50), which was statistically different fromthose in group N (0) and group C (0) (both P<0.05).There were no statistical differences in general data, VAS scores at other timepoints, improved Bromage scores at all the time points, time of labor, cesareansection rate, instrumental delivery rate, oxytocin utilization rate, Apgarscore of newborns, and umbilical artery blood gas analysis between the threegroups (all P>0.05). Conclusion　Intravenous infusionof small doses of nalbuphine and remifentanil can significantly relieve thepain level before epidural labor analgesia takes effect and alleviate maternaltension, so that the puerperae can better cooperate with the anesthesiologists'instructions, create more favorable conditions for the anesthesia operation,improve their satisfaction, do not affect the delivery mode, do not prolong thelabor process, and do not increase the occurrence of maternal and infantserious adverse reactions.