不同纳布啡PCIA给药参数对瘢痕子宫剖宫产产妇术后疼痛、泌乳功能的影响-现代医学

不同纳布啡PCIA给药参数对瘢痕子宫剖宫产产妇术后疼痛、泌乳功能的影响

单位：1. 成都市新都区第三人民医院麻醉科, 四川成都 610000;
2. 西部战区总医院麻醉科, 四川成都 610083

分类号：R271

出版年·卷·期（页码）：2025·53·第五期（779-785）

摘要：

目的： 探讨不同纳布啡自控静脉镇痛(PCIA)给药参数在瘢痕子宫剖宫产产妇中的应用效果。方法： 选取2021年1月至2024年1月成都市新都区第三人民医院收治的瘢痕子宫剖宫产产妇150例，随机数字表法分为A、B、C组，每组50例。3组均在腰-硬联合麻醉下进行剖宫产，术后连接PCIA(配制3 mg格拉司琼、2 mg·kg^-1纳布啡，加生理盐水至100 mL)，A组设置背景量2 mL·h^-1，自控按压2 mL·次^-1；B组设置背景量1 mL·h^-1，自控按压3 mL·次^-1；C组设置背景量0 mL·h^-1，自控按压4 mL·次^-1，锁定时间均为15 min。统计3组产妇术后各时间点视觉模拟评分法(VAS)评分、纳布啡消耗量，比较手术前后血清前列腺素E₂(PGE₂)、P物质(SP)、神经肽Y(NPY)等疼痛介质，肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)等炎症因子，催乳素(PRL)水平，并统计3组产妇泌乳始动时间、不良反应发生率。结果： A组剔除临床数据不全1例、退出1例，纳入48例；B组剔除临床数据不全1例，纳入49例；C组剔除术后大出血1例，纳入49例。C组术后6 h、术后24 h的VAS评分高于A组(P＜0.05)；B、C组术后12 h的VAS评分高于A组，且C组VAS评分高于B组(P＜0.05)。C组术后24 h的血清PGE₂、SP水平高于A、B组，血清NPY水平低于A组(P＜0.05)。C组术后24 h的血清TNF-α、IL-6水平高于A、B组(P＜0.05)。B、C组术后12 h、术后24 h的纳布啡消耗量均低于A组(P＜0.05)；B、C组术后48 h的纳布啡消耗量均低于A组，且C组纳布啡消耗量低于B组(P＜0.05)。C组术后24 h的血清PRL水平低于A、B组(P＜0.05)；C组泌乳始动时间长于A、B组(P＜0.05)。3组不良反应发生率比较无显著差异(P＞0.05)。结论： 背景量1 mL·h^-1+自控按压3 mL·次^-1的纳布啡PCIA给药方法可在减少纳布啡消耗量的同时发挥有效的镇痛作用，调节疼痛介质释放，降低炎症因子水平，促进泌乳功能恢复，可作为瘢痕子宫剖宫产产妇术后合理的纳布啡PCIA给药参数。

Objective: To investigate the effect of different nalbuphine patient-controlled intravenous analgesia(PCIA) administration parameters in parturients with cicatricial uterus cesarean section. Methods: 150 parturients with cesarean section of cicatricial uterus in the Third People's Hospital of Xindu District from January 2021 to January 2024 were selected and randomly divided into group A, group B and group C, with 50 cases in each group. All the three groups underwent cesarean section under combined lumbo-epidural anesthesia, and were connected with PCIA(preparation of 3 mg granisetron, 2 mg·kg^-1 nalbuphine, plus normal saline to 100 mL) after operation. Group A was set with background volume of 2 mL·h^-1 and self-controlled compression of 2 mL each time. Group B was set with a background volume of 1 mL·h^-1 and self-controlled compression of 3 mL each time. Group C was set with a background volume of 0 mL·h^-1, self-controlled compression of 4 mL each time, and lock time of 15 min. Visual Analogue Scale(VAS) score and nalbuphine consumption were calculated at each time point after delivery and gynecology in the three groups. The levels of serum pain mediators [prostaglandin E₂(PGE₂), substance P(SP), neuropeptide Y(NPY)], inflammatory factors [tumor necrosis factor-α(TNF-α), interleukin-6(IL-6)] and prolactin(PRL) before and after operation were compared. The start time of lactation and the incidence of adverse reactions were analyzed. Results: Group A excluded 1 patient with incomplete clinical data, 1 patient with self-withdrawal, and 48 patients were included; Group B excluded 1 patient with incomplete clinical data, including 49 cases; In group C, there was 1 case of postoperative massive hemorrhage, and 49 cases were included. At 6 h and 24 h after operation, the VAS score of group C was higher than that of group A(P < 0.05). The VAS scores of groups B and C were higher than that of group A at 12 h after operation, and the VAS score of group C was higher than that of group B(P < 0.05). At 24 h after operation, the serum PGE₂ and SP levels in group C were higher than those in groups A and B, and the serum NPY level was lower than that in group A(P < 0.05). The serum levels of TNF-α and IL-6 in group C were higher than those in groups A and B at 24 h after operation(P < 0.05). The consumption of nalbuphine in groups B and C was lower than those in group A at 12 h and 24 h after operation(P < 0.05).At 48 h after operation, the consumption of nalbuphine in groups B and C were lower than that in group A,moreover, the consumption of nalbuphine in group C was lower than that in group B(P<0.05). At 24 h after operation, the serum PRL level of group C was lower than those of groups A and B(P<0.05). The lactation start time of group C was longer than those of groups A and B(P<0.05). There was no significant difference in the incidence of adverse reactions among the three groups(P > 0.05). Conclusion: The nalbuphine PCIA administration method with a background volume of 1 mL·h^-1+3 mL each time of self-controlled compression can play an effective analgesic effect while reducing the consumption of nalbuphine, regulating the release of pain mediators, reducing levels of inflammatory factors, and promoting the recovery of lactation function, and can be used as a reasonable nalbuphine PCIA administration parameters with the gynecography of cicatricial uterus after cesarean section.

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