【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。更多还原

【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 between2 groups（P>0.05）. VAS scores of 2 groups at T_2-3 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 T₃-4were 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 2groups 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 T_3-4 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.更多还原