摘要
目的探究剖宫产术后纳布啡不同配置浓度自控硬膜外镇痛对高龄孕妇疼痛及泌乳素的影响。方法回顾性分析2022年1月至2024年2月唐山市妇幼保健院行剖宫产术分娩的高龄孕妇116例,术后采用纳布啡自控硬膜外镇痛,按照纳布啡配置浓度分为大背景量组(n=38,背景量2 mL/h,单次按压2 mL)、小背景量组(n=40,背景量1 mL/h,单次按压2 mL)、无背景量组(n=38,无背景量,单次按压4 mL)。比较3组术后给药情况(纳布啡总消耗量、镇痛泵按压次数),术后2、6、12、24 h的镇痛效果[视觉模拟疼痛评分法(VAS)评分]、镇静效果(Ramsay评分)及泌乳素水平。结果3组纳布啡总消耗量从高到低依次为大背景量组[(114.15±28.86)mg]、小背景量组[(101.35±21.47)mg]、无背景量组[(90.56±14.72)mg],镇痛泵按压次数从高到低依次为无背景量组[(18.12±3.37)次]、小背景量组[(13.25±2.24)次]、大背景量组[(12.87±3.42)次],组间比较差异均有统计学意义(P<0.05)。各组内VAS评分随着时间推移呈现出逐渐下降趋势,小背景量组、无背景量组各时间点评分比较,差异均有统计学意义(P<0.05),但大背景量组组内评分比较,差异无统计学意义(P>0.05);3组术后2、6、12、24 h的VAS评分组间比较,差异均无统计学意义(P>0.05)。各组内Ramsay评分随着时间延长逐渐下降,各时间点评分比较差异均有统计学意义(P<0.05);3组术后2、6、12、24 h的Ramsay评分组间比较,差异均无统计学意义(P>0.05)。各组内泌乳素水平比较结果显示术后随着时间延长逐渐增高,恢复至正常水平,差异有统计学意义(P<0.05)。大背景量组术后2、6、12、24 h泌乳素水平分别为(180.89±10.86)、(213.57±33.62)、(234.93±31.69)、(232.51±48.73)mmol/L,小背景量组术后2、6、12、24 h泌乳素水平分别为(186.86±12.72)、(243.62±30.87)、(279.91±35.75)、(289.47±32.68)mmol/L,无背景量组术后2、6、12、24 h泌乳素水平分别为(185.77±14.91)、(240.58±25.03)、(273.05±27.81)、(281.63±21.94)mmol/L。各组内泌乳素水平术后随着时间延长逐渐增高,差异均有统计学意义(P<0.05);大背景量组术后6、12、24 h的泌乳素水平均低于小背景量组与无背景量组,差异均有统计学意义(P<0.05);小背景量组与无背景量组术后2、6、12、24 h的泌乳素水平比较,差异均无统计学意义(P>0.05)。3组总不良反应发生率比较,差异无统计学意义(P>0.05)。结论纳布啡配置浓度背景量1 mL/h应用于剖宫产术后自控硬膜外镇痛效果较好,既可以满足镇痛、镇静需求,又可以减少纳布啡消耗量,降低对高龄产妇的泌乳素影响,镇痛效果显著。
Objective To explore the effects of controlled epidural analgesia with different concentrations of nalbuphine after cesarean section on pain and prolactin in elderly pregnant women.Methods A retrospective analysis was performed on 116 elderly pregnant women who underwent cesarean section in Tangshan Maternal and Child Health Hospital from January 2022 to February 2024.Postoperative patient-controlled epidural analgesia with nalbuphine was used.According to the concentration of nalbuphine,the patients were divided into the large background group(n=38,background volume 2 mL/h,single compression 2 mL),the small background group(n=40,background volume 1 mL/h,single compression 2 mL),and the no background group(n=38,no background volume,single compression 4 mL).The postoperative administration(total consumption of nalbuphine,number of analgesic pump compressions),analgesia[visual analog scale(VAS)score],sedative effect(Ramsay score)and prolactin level were compared among the three groups.Results The total consumption of nalbuphine in the three groups from high to low was large background group[(114.15±28.86)mg],the small background group[(101.35±21.47)mg],and the no background group[(90.56±14.72)mg],the number of analgesic pump presses from high to low was the no background group[(18.12±3.37)times],the small background group[(13.25±2.24)times],and the large background group[(12.87±3.42)times],the differences between the groups were statistically significant(P<0.05).The VAS score in each group showed a gradual downward trend with the passage of time,there were statistically significant differences in the scores between the small background group and the non-background group at each time point(P<0.05),there was no statistically significant difference in the scores within the large background group(P>0.05);there were no statistically significant differences in VAS scores between the three groups at 2,6,12 and 24 h after operation(P>0.05).The Ramsay scores in each group gradually decreased with time,and the differences in scores at each time point were statistically significant(P<0.05).There were no statistically significant differences in Ramsay scores between the three groups at 2,6,12 and 24 h after operation(P>0.05).The prolactin levels in the large background group at 2,6,12 and 24 h after operation were(180.89±10.86),(213.57±33.62),(234.93±31.69)and(232.51±48.73)mmol/L,respectively.The prolactin levels in the small background group at 2,6,12 and 24 h after operation were(186.86±12.72),(243.62±30.87),(279.91±35.75)and(289.47±32.68)mmol/L,respectively.The prolactin levels in the non-background group at 2 h,6 h,12 h and 24 h after operation were(185.77±14.91),(240.58±25.03),(273.05±27.81)and(281.63±21.94)mmol/L,respectively.The level of prolactin in each group increased gradually with time after operation,and the differences were statistically significant(P<0.05).The prolactin levels at 6,12 and 24 h after operation in the large background group were lower than those in the small background group and the non-background group,and the differences were statistically significant(P<0.05);there were no statistically significant differences in prolactin levels between the small background group and the non-background group at 2,6,12 and 24 h after operation(P>0.05).There was no statistically significant difference in the incidence of total adverse reactions among the three groups(P>0.05).Conclusion The background concentration of nalbuphine with a concentration of 1 mL/h is applied to self-controlled epidural analgesia after cesarean section,which can not only meet the needs of analgesia and sedation,but also reduce the consumption of nalbuphine and reduce the effect of prolactin on elderly women,and the analgesic effect is significant.
作者
叶海宾
皇甫彪
李莉
白耀武
YE Hai-bin;HUANG Fu-biao;LI Li(Department of Anesthesiology,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China;Department of Obstetrics,Tangshan Maternal and Child Health Hospital,Tangshan Hebei 063000,China)
出处
《临床和实验医学杂志》
2025年第9期997-1000,共4页
Journal of Clinical and Experimental Medicine
基金
河北省2024年度医学科学研究课题计划(编号:20241121)。
关键词
剖宫产
高龄孕妇
纳布啡
自控硬膜外镇痛
泌乳素
Cesarean section
Elderly pregnant women
Nalbuphine
Controlled epidural analgesia
Prolactin
