纳布啡复合罗哌卡因对分娩产妇镇痛效果及母婴的影响

王传荣 张一娇

【摘要】 目的 探討纳布啡复合罗哌卡因对分娩产妇镇痛效果及母婴的影响。

方法 以安徽省临泉县人民医院2018年12月至2020年12月自愿接受分娩镇痛的180例单胎足月初产妇为研究对象，采用单双号法分为两组，每组90例。麻醉药物：A组产妇予0.2 mg/mL纳布啡+0.1%罗哌卡因，B组产妇予0.2 μg/mL舒芬太尼+0.1%罗哌卡因。分析两组产妇在镇痛前、镇痛后15分钟、镇痛后30分钟以及宫口开全时的VAS评分;采用Bromage运动阻滞评分评价两组的运动阻滞程度;比较两组产妇分娩期间不良反应发生情况以及新生儿Apgar评分，并进行血气分析和乳酸值测定，产后24 h采用新生儿神经行为评分（NABA）对新生儿神经行为进行评价;测定产妇分娩后24 h的泌乳素分泌情况。

结果 镇痛后15分钟、镇痛后30分钟以及宫口开全时，A组产妇的VAS评分明显低于B组（P<0.05）。A组产妇发生瘙痒和恶心呕吐的比例均低于B组（P<0.05）;两组产妇Bromage评分等级和血清泌乳素水平之间的差异无统计学意义（P>0.05）。A组新生儿出生后1分钟的Apgar评分（9.24±0.31）分高于B组（8.97±0.24）分，差异有统计学意义（P<0.05）;出生后5分钟，两组新生儿的Apgar评分差异无统计学意义（P>0.05）。两组新生儿脐动脉血在pH值、乳酸、PCO2、PO2以及产后24小时NABA等参数比较差异无统计学意义（P>0.05）。

结论 纳布啡复合罗哌卡因的麻醉方式在硬膜外自控分娩中的镇痛效果优良，具有较好的安全性，对新生儿亦无明显影响。

【关键词】 纳布啡;罗哌卡因;舒芬太尼;分娩镇痛;血气分析;安全性

中图分类号：R614.4+2   文献标志码：A   DOI：10.3969/j.issn.1003-1383.2021.10.005

Effect of nalbuphine combined with ropivacaine on labor analgesia in parturient women and its influence on mothers and infants

WANG Chuanrong1， ZHANG Yijiao2

（1.Department of Gynaecology and Obstetrics， People's Hospital of Linquan County， Linquan 236400， Anhui， China; 2. Department of Reproductive Medicine， Handan Central Hospital， Handan 056004， Hebei， China）

【Abstract】 Objective To explore the effect of nalbuphine combined with ropivacaine on labor analgesia in parturient women and its influence on mothers and infants.

Methods A total of 180 singleton full-term primiparas who voluntarily received labor analgesia in People's Hospital of Linquan County of Anhui Province from December 2018 to December 2020 were selected as research objects. All of them were divided into 2 groups by odd and even numbers， with 90 cases in each group. Group A were given 0.2 mg/mL nalbuphine + 0.1% ropivacaine for maternal anesthesia， and group B were given 0.2 μg/mL sufentanil + 0.1% ropivacaine for maternal anesthesia. And then， VAS scores before analgesia， 15 minutes after analgesia， 30 minutes after analgesia and the time of uterine full opening were analyzed; Bromage motor block score was used to evaluate the degree of motor block in the two groups; the incidence of adverse reactions during delivery and neonatal Apgar scores were compared between the two groups， and blood gas analysis and lactate value were measured; neonatal behavioral neurological assessment （NABA） was used to evaluate neonatal neurobehavior 24 hours after delivery; the secretion of prolactin was measured 24 hours after delivery.

Results The VAS scores of the group A were significantly lower than those in the group B at 15 minutes and 30 minutes after analgesia and at the time of uterine full opening， and the VAS score of the group A was significantly lower than that of the group B （P < 0.05）. The proportions of itching， nausea and vomiting in the group A were significantly lower than those in the group B （P < 0.05）; there was no statistically significant difference in the maternal Bromage scores and serum prolactin levels between the two groups （P > 0.05）. The Apgar score （9.24±0.31） of newborns in the group A was significantly higher than that of the group B （8.97±0.24） at 1 minute after delivery， and difference was statistically significant（P < 0.05）. There was no statistically significant difference in Apgar scores between the two groups at 5 minutes after delivery （P > 0.05）. There was no statistically significant difference of neonatal umbilical artery blood in the parameters of pH value， lactic acid， PCO PO2 in umbilical cord blood and NABA 24 hours after delivery （P > 0.05）.

Conclusion The anesthesia method of nalbuphine combined with ropivacaine has an excellent analgesic effect in patient-controlled epidural delivery， which has good safety without obvious effects on newborns.

【Key words】 nalbuphine; ropivacaine; sufentanil; labor analgesia; blood gas analysis; safety

硬膜外镇痛是一种中枢神经阻滞技术，广泛应用于分娩镇痛，是分娩镇痛最有效的方法[1～2]。在缓解分娩疼痛和提高产妇的满意度方面，硬膜外镇痛比非硬膜外镇痛更有效[3]。为了减少局麻药的用量，提高分娩镇痛的效果，在硬膜外镇痛时通常会在局麻药中加入阿片类激动剂[4]。硬膜……