纳布啡联合氟比洛芬酯用于剖宫产术后产妇镇痛的临床效果

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1、授予单位代码10089学号或申请号16056中国图书分类号R614HebeiMedicalUniversity硕士学位论文学术学位纳布啡联合氟比洛芬酯用于剖宫产术后产妇镇痛的临床效果研究生：张弘扬导师：贾丽副教授专业：麻醉学二级学院：第四医院2018年3月目录中文摘要···············································································1英文摘要·······················································

2、························3研究论文纳布啡联合氟比洛芬酯用于剖宫产术后产妇镇痛的临床效果前言···············································································5材料与方法·····································································6结果···························································

3、····················9附图·············································································10附表·············································································13讨论·············································································16结论·······

4、·······································································22参考文献······································································22综述盐酸纳布啡临床应用新进展··············································26致谢····························································

5、······················36个人简历···········································································37纳布啡联合氟比洛芬酯用于剖宫产术后产妇镇痛的临床效果摘要目的:本研究探讨盐酸纳布啡联合氟比洛芬酯用于剖宫产术后产妇静脉自控镇痛（PCIA）的临床效果。方法：选择2017年1～月2018年1月经我院收治的择期行剖宫产术的足月单胎初产妇120例，ASA分级Ⅰ级或Ⅱ级，产妇身高为155～173cm，年龄20～35岁之间，产妇均为足月妊娠，无

6、明显心肺功能障碍，术前血压、血糖、血尿常规、凝血、心电图、心脏彩超及肝、肾功能未见异常，无畸形且穿刺部位皮肤无感染，无内分泌系统及心血管系统疾病，符合剖宫产手术指征，产妇思路清晰，可配合手术。应用随机数字法将所有产妇分为纳布啡组（N组）60例:纳布啡＋氟比洛芬酯;和舒芬太尼组(S组)60例，枸橼酸舒芬太尼＋氟比洛芬酯。产妇术前常规8h禁食2h禁水，在腰-硬联合麻醉下行子宫下段剖宫产术，麻醉平面调整在T6水平。术中连续监测收缩压（SBP）、舒张压（DBP）、心率（HR）、心电图(ECG)、血氧饱和度（SPO）。胎儿顺利取出剪断脐带后，静脉连

7、接镇痛泵实施静脉自控镇痛（PCIA）。镇痛泵药物：N组为纳布啡（1mg/kg）＋氟比洛芬酯(3mg/kg)，S组为枸橼酸舒芬太尼（1μg/kg）＋氟比洛芬酯(3mg/kg)，均用生理盐水稀释到100ml。镇痛泵参数：背景流速2ml/h，按压一次0.5ml，锁定时间15min。于术后2、4、6、12、24、48h记录产妇的SBP、DBP、HR和SPO2，并评估产妇动、静态的VAS疼痛评分和Ramsay镇静评分。术后2h内每30min做一次宫底按摩，促进恶露排出，记录产妇每次子宫按摩时的VAS疼痛评分。记录术后镇痛过程中产妇尿储留、恶心、呕吐、

8、呼吸抑制等不良反应的发生情况。镇痛结束后询问产妇对镇痛的满意程度，分优、良、可、差四个等级。结果：两组产妇的年龄、身高、体重、孕周等比较差异无统计学意义（P＞0.05）。两组产妇