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三种浓度纳布啡静脉给药复合氢吗啡酮用于剖宫产术后镇痛的比较研究。

A comparative study of three concentrations of intravenous nalbuphine combined with hydromorphone for post-cesarean delivery analgesia.

机构信息

Department of Anesthesia, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310006, China.

出版信息

Chin Med J (Engl). 2020 Mar 5;133(5):523-529. doi: 10.1097/CM9.0000000000000678.

DOI:10.1097/CM9.0000000000000678

PMID:32142492

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7065868/

Abstract

BACKGROUND

Nalbuphine has been suggested to be used for post-cesarean section (CS) intravenous analgesia. However, ideal concentration of nalbuphine for such analgesia remains unclear. The present study was conducted to explore an ideal concentration of nalbuphine for post-CS intravenous analgesia by evaluating the analgesic effects and side-effects of three different concentrations of nalbuphine combined with hydromorphone for post-CS intravenous analgesia in healthy parturients.

METHODS

One-hundred-and-fourteen parturients undergoing elective CS were randomly allocated to one of three groups (38 subjects per group) according to an Excel-generated random number sheet to receive hydromorphone 0.05 mg/mL + nalbuphine 0.5 mg/mL (group LN), hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL (group MN), and hydromorphone 0.05 mg/mL + nalbuphine 0.9 mg/mL (group HN) using patient-controlled analgesia (PCA) pump. Visual analog scale (VAS) for pain, PCA bolus demands, cumulative PCA dose, satisfaction score, Ramsay score, and side-effects such as urinary retention were recorded.

RESULTS

The number of PCA bolus demands and cumulative PCA dose during the first 48 h after CS were significantly higher in group LN (21 ± 16 bolus, 129 ± 25 mL) than those in group MN (15 ± 10 bolus, 120 ± 16 mL) (both P < 0.05) and group HN (13 ± 9 bolus, 117 ± 13 mL) (both P < 0.01), but no difference was found between group HN and group MN (both P > 0.05). VAS scores were significantly lower in group HN than those in group MN and group LN for uterine cramping pain at rest and after breast-feeding within 12 h after CS (all P < 0.01) and VAS scores were significantly higher in group LN than those in group MN and group HN when oxytocin was intravenously infused within 3 days after CS (all P < 0.05), whereas VAS scores were not statistically different among groups for incisional pain (all P > 0.05). Ramsay sedation scale score in group HN was significantly higher than that in group MN at 8 and 12 h after CS (all P < 0.01) and group LN at 4, 8, 12, 24 h after CS (all P < 0.05).

CONCLUSIONS

Hydromorphone 0.05 mg/mL + nalbuphine 0.7 mg/mL for intravenous PCA could effectively improve the incisional pain and uterine cramping pain management and improve comfort in patients after CS.

TRIAL REGISTRATION NUMBER

ChiCTR1800015014, http://www.chictr.org.cn/ Chinese Clinical Trial Registry.

摘要

背景

纳布啡已被建议用于剖宫产术后（CS）静脉镇痛。然而，用于此类镇痛的纳布啡的理想浓度仍不清楚。本研究旨在通过评估三种不同浓度的纳布啡联合氢吗啡酮用于 CS 后静脉镇痛对健康产妇的镇痛效果和副作用，探索 CS 后静脉镇痛的理想纳布啡浓度。

方法

114 例择期 CS 产妇按 Excel 生成的随机数表分为三组（每组 38 例），接受氢吗啡酮 0.05mg/mL+纳布啡 0.5mg/mL（LN 组）、氢吗啡酮 0.05mg/mL+纳布啡 0.7mg/mL（MN 组）和氢吗啡酮 0.05mg/mL+纳布啡 0.9mg/mL（HN 组）的患者自控镇痛（PCA）泵治疗。记录视觉模拟评分（VAS）疼痛、PCA 冲击剂量需求、累积 PCA 剂量、满意度评分、 Ramsay 镇静评分以及尿潴留等副作用。

结果

CS 后 48 小时内，LN 组（21±16 次冲击剂量，129±25mL）的 PCA 冲击剂量需求和累积 PCA 剂量明显高于 MN 组（15±10 次冲击剂量，120±16mL）（均 P<0.05）和 HN 组（13±9 次冲击剂量，117±13mL）（均 P<0.01），但 HN 组与 MN 组之间无差异（均 P>0.05）。CS 后 12 小时内，HN 组的子宫痉挛性疼痛在休息和哺乳时的 VAS 评分明显低于 MN 组和 LN 组（均 P<0.01），CS 后 3 天内静脉滴注催产素时，LN 组的 VAS 评分明显高于 MN 组和 HN 组（均 P<0.05），而切口疼痛的 VAS 评分在各组间无统计学差异（均 P>0.05）。CS 后 8 和 12 小时，HN 组的 Ramsay 镇静评分明显高于 MN 组（均 P<0.01）和 LN 组（均 P<0.05）；CS 后 4、8、12、24 小时，HN 组的 Ramsay 镇静评分明显高于 MN 组（均 P<0.05）。