吗啡与纳布啡对剖宫产产妇术后相关指标的影响比较-中国药房

吗啡与纳布啡对剖宫产产妇术后相关指标的影响比较

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篇名：	吗啡与纳布啡对剖宫产产妇术后相关指标的影响比较
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摘要：	目的：比较吗啡与纳布啡对剖宫产产妇术后相关指标的影响。方法：120例行剖宫产术的产妇随机分为观察组（60例）和对照组（60例）。术后，观察组产妇采用盐酸纳布啡注射液20 mg+0.75％盐酸罗哌卡因注射液20 mL，硬膜外自控镇痛；对照组产妇采用盐酸吗啡注射液8 mg+0.75％盐酸罗哌卡因注射液20 mL，硬膜外自控镇痛。观察并比较两组产妇镇痛开始时（T0）、镇痛后6 h（T1）、12 h（T2）、24 h（T3）、48 h（T4）时的视觉模拟疼痛（VAS）评分、收缩压、舒张压、呼吸速率（RR）、血氧饱和度（SpO2），T0、T3、T4时的白细胞介素6（IL-6）、IL-8、C反应蛋白（CRP）、泌乳素（PRL）水平，镇痛满意率及不良反应发生情况。结果：两组产妇镇痛满意率比较，差异无统计学意义（96.67％ vs. 98.33％，P＞0.05）。两组产妇T0、T1、T4时VAS评分比较，差异均无统计学意义（P＞0.05）；T2-3时，两组产妇VAS评分均显著高于同组T0、T1及T4时，差异均有统计学意义（P＜0.05）；但两组间比较，差异均无统计学意义（P＞0.05）。两组产妇T0-2时的收缩压及不同时间点的舒张压、RR、SpO2比较，差异均无统计学意义（P＞0.05）；两组产妇T3-4时收缩压均显著高于同组T0时，差异均有统计学意义（P＜0.05）；但两组间比较差异均无统计学意义（P＞0.05）。T0时，两组产妇IL-6、IL-8、CRP、PRL水平比较，差异均无统计学意义（P＞0.05）。T3时，两组产妇IL-6、IL-8、CRP水平均显著高于同组T0时，但观察组显著低于对照组；T4时，对照组产妇IL-6、IL-8、CRP水平均显著高于同组T0时，差异均有统计学意义（P＜0.05），而观察组产妇T0与T4时比较，差异均无统计学意义（P＞0.05）。两组产妇T3-4时PRL水平均显著高于同组T0时，随时间延长逐渐升高，且观察组显著高于对照组，差异均有统计学意义（P＜0.05）。观察组产妇不良反应发生率显著低于对照组，差异有统计学意义（P＜0.05）。结论：纳布啡用于剖宫产产妇术后的镇痛效果、心血管影响与吗啡相当，但在降低炎性水平、促进泌乳、安全性方面优于吗啡。
ABSTRACT：	OBJECTIVE： To compare the effects of morphine and nalbuphine on related indexes of maternal after cesarean section. METHODS： A total of 120 maternal underwent cesarean section were randomly divided into observation group （60 cases） and control group （60 cases）. After surgery， observation group was given Nalbuphine hydrochloride injection 20 mg+0.75％ Ropivacaine hydrochloride injection 20 mL for patient-controlled epidural analgesia. Control group was given Morphine hydrochloride injection 8 mg+0.75％ Ropivacaine hydrochloride injection 20 mL for patient-controlled epidural analgesia. VAS score， systolic pressure， diastolic pressure， respiration rate （RR）， SpO2 at the onset of analgesia （T0）， 6 h （T1）， 12 h （T2）， 24 h （T3） and 48 h （T4） after analgesia as well as the levels of IL-6， IL-8， CRP and PRL at T0， T3， T4 were observed in 2 groups. The satisfaction rate of analgesia and the occurrence of ADR were also observed. RESULTS： There was no statistical significance in satisfaction rate of analgesia between 2 groups （96.67％ vs. 98.33％，P＞0.05）. At T0， T1， T4， there was no statistical significance in VAS score between 2 groups （P＞0.05）. VAS scores of 2 groups at T2-3 were significantly higher than at T0， T1， T4， with statistical significance （P＜0.05）； but there was no statistical significance between 2 groups （P＞0.05）. There was no statistical significance in diastolic pressure， RR and SpO2 between 2 groups at T0-2（P＞0.05）. The systolic pressure of 2 groups at T3-4 were significantly higher than at T0， with statistical significance （P＜0.05）； but there was no statistical significance between 2 groups （P＞0.05）. There was no statistical significance in the levels of IL-6， IL-8， CRP or PRL between 2 groups at T0（P＞0.05）. The levels of IL-6， IL-8 and CRP in 2 groups at T3 were significantly higher than at T0， but the observation group was significantly lower than the control group； at T4， the levels of IL-6， IL-8 and CRP in control group were significantly higher than at T0， with statistical significance （P＜0.05），but there was no statistical significance in observation group， compared to at T0 （P＞0.05）. The levels of PRL in 2 groups at T3-4 were significantly higher than at T0， and increased gradually as time； the observation group and significantly higher than the control group， with statistical significance （P＜0.05）. The incidence of ADR in observation group was significantly lower than control group， with statistical significance （P＜0.05）. CONCLUSIONS： For maternal after cesarean section，nalbuphine is similar to morphine in analgesic effect and cardiovascular effect， but it is better than morphine in reducing inflammatory level， promoting lactation and safety.
期刊：	2017年第28卷第21期
作者：	丁亚平，魏万鹏，和建杰
AUTHORS：	DING Yaping，WEI Wanpeng，HE Jianjie
关键字：	吗啡；纳布啡；剖宫产；硬膜外自控镇痛；镇痛效果；安全性
KEYWORDS：	Morphine； Nalbuphine； Cesarean section； Patient-controlled epidural analgesia； Analgesic effect； Safety
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