摘要
目的确定纳布啡用于剖宫产术后PCIA适宜的配制剂量。方法择期行剖宫产术患者100例，年龄22～40岁，体重60～90 kg，ASA分级Ⅰ或Ⅱ级，孕周≥37周。采用随机数字表法分4组（n＝25）：舒芬太尼2.0 μg/kg（S组）、纳布啡1.5 mg/kg（N1组）、纳布啡2.0 mg/kg（N2组）和纳布啡2.5 mg/kg（N3组）分别加入PCIA泵，加入托烷司琼12 mg后用生理盐水稀释至100 ml，负荷量3 ml，背景剂量2 ml/h，PCA剂量1 ml/次，锁定时间10 min。静脉注射曲马多50 mg进行补救镇痛，维持静态VAS评分≤4分或动态（咳嗽）VAS评分≤6分。记录术后48 h内最高Ramsay镇静评分、补救镇痛情况、PCIA无效按压次数和总按压次数、恶心呕吐、皮肤瘙痒、嗜睡的发生情况。结果与S组比较，N2组和N3组PCIA无效按压次数、总按压次数及补救镇痛率降低，N3组嗜睡发生率及最高Ramsay镇静评分升高（P〈0.05），N1组上述各指标差异无统计学意义（P〉0.05）；与N1组比较，N2组和N3组PCIA无效按压次数、总按压次数及补救镇痛率降低，N3组嗜睡发生率及最高Ramsay镇静评分升高（P〈0.05）；与N2组比较，N3组嗜睡发生率及最高Ramsay镇静评分升高（P〈0.05），PCIA无效按压次数、总按压次数及补救镇痛率差异无统计学意义（P〉0.05）。结论纳布啡用于剖宫产术后PCIA适宜的配制剂量为2.0 mg/kg。
Objective To determine the optimum dose of nalbuphine prepared for patient-controlled intravenous analgesia（PCIA）after caesarean section.Methods A total of 100 parturients, aged 22-40 yr, weighing 60-90 kg, of American Society of Anesthesiologists physical statusⅠor Ⅱ, at≥37 weeks of gestation, scheduled for elective caesarean section, were divided into 4 groups（n=25 each）using a random number table： sufentanil 2.0 μg/kg group（group S）, nalbuphine 1.5 mg/kg group（group N1）, nalbuphine 2.0 mg/kg group（group N2）and nalbuphine 2.5 mg/kg group（group N3）. In S, N1, N2 and N3 groups, sufentanil 2.0 μg/kg and nalbuphine 1.5, 2.0 and 2.5 mg/kg were added to PCIA solution, respectively, tropisetron 12 mg was added, and PCIA solution was then diluted to 100 ml in normal saline.The PCA pump was set up to deliver a 1 ml bolus dose with a 10-min lockout interval and background infusion at 2 ml/h after a loading dose of 3 ml.Tramadol 50 mg was intravenously injected as a rescue analgesic to maintain visual analogue scale score at rest ≤4 or during activity（cough）≤6.The highest Ramsay sedation score, requirement for rescue analgesics, the number of unsuccessfully delivered doses, the number of attempts and occurrence of nausea and vomiting, pruritus and somnolence within 48 h after operation were recorded.Results Compared with group S, the number of unsuccessfully delivered doses, the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups, the incidence of somnolence and the highest Ramsay sedation scores were increased in group N3（P〈0.05）, and no significant change was found in the parameters mentioned above in group N1（P〉0.05）. Compared with group N1, the number of unsuccessfully delivered doses, the number of attempts and requirement for rescue analgesics were significantly decreased in N2 and N3 groups, and the incidence of somnolence and the highest Ramsay sedation scores were increased in group N3（P〈0.05）. Compared with group N2, the incidence of somnolence and the highest Ramsay sedation scores were significantly increased（P〈0.05）, and no significant difference was found in the number of unsuccessfully delivered doses, the number of attempts or requirement for rescue analgesics in group N3 （P〉0.05）.Conclusion The optimum dose of nalbuphine prepared for PCIA after caesarean section is 2.0 mg/kg.
出处
《中华麻醉学杂志》
CSCD
北大核心
2017年第4期478-480,共3页
Chinese Journal of Anesthesiology
关键词
纳布啡
剖宫产术
疼痛
手术后
镇痛
病人控制
Nalbuphine
Caesarean section
Pain, postoperative
Analgesia, patient-controlled
