Observation On The Adverse Reactions Of Intrathecal Morphine Analgesia After Cesarean Section By Intravenous Injection Of Different Doses Of Nalbuphine

Objective:Analgesia after cesarean section is a hot topic in current research.At present,the effect of intrathecal morphine analgesia is exact,but adverse reactions such as nausea,vomiting and itching often occur.As a mixedκopioid receptor agonist andμopioid receptor antagonist,nalbuphine has the advantages of inhibiting visceral pain and small side effects.However,the current clinical doses for intravenous administration of nalbuphine to alleviate adverse reactions caused by opioids have not been unified.Therefore,based on previous studies at home and abroad,this study mainly analyzed the effects of different doses of nalbuphine on the adverse reactions induced by intrathecal morphine after cesarean section.Methods:200 cases of obstetric patients who underwent cesarean section in the lower uterus of the Second People’s Hospital of Wuhu City from October 2018 to March 2019were selected as subjects.They were randomly divided into N-1 groups and N groups.50 patients in group-2,N-3 group and P group,all underwent surgery under combined spinal and epidural anesthesia.After umbilical cord injury:each group in the experimental group was intravenously injected with 0.1%saline diluted to 0.9ml with0.1%normal saline.0.15 mg/kg,0.20 mg/kg nalbuphine,and the control group were intravenously injected with 10 ml of 0.9%physiological saline.The general condition of the operation was recorded.The systolic blood pressure was observed and analyzed after 3h（T0）,6h（T1）,12h（T2）,24h（T3）and 48h（T4）ystolic blood pressure（SBP）,diastolic blood pressure（DBP）,heart rate（HR）,and pulse oximetry（SpO₂）were evaluated for analgesia in 24 hours after surgery[pain visual analogue scale（VAS）]and sedative effect（Ramsay score）,pruritus score,incidence of adverse reactions,supplemental medication,and observation of changes in prolactin（PRL）levels in each group,assessment of postpartum depression in each group[Chinese version of Postpartum Depression Screening（PDSS）],overall satisfaction.Results:（1）There was no significant differences in the operation time,intraoperative blood loss or transfusion volume among the four groups（P>0.05）.（2）There were statistically significant differences in SBP,DBP and HR among the four groups from T0to T4（P<0.05）,but there was no significant differences in SpO₂（P>0.05）.TheSBP,DBP and HR of N-2 group were lower than those of N-1 group,N-3 group and P group at T2 and T3（P<0.05）.There was no significant differences in SBP,DBP,HR or SpO₂between any two groups of the other groups（P>0.05）.（3）The VAS scores of N-1 group,N-2 group and N-3 group were lower than that of P group at 6 h,12h and 24 h after operation（P<0.05）,and the VAS scoreof N-2 group at each time point was the lowest（P<0.05）.（4）The Ramsay scores of N-1 group,N-2 group and N-3 group were lower than those of P group at 6h,12h and 24h after operation（P<0.05）,and the Ramsay scoreof N-2 group at each time pointwas the lowest（P<0.05）.（5）The grades of itching scores of N-1 group,N-2 group and N-3 group were lower than those of group P within24 hours after operation（P<0.05）,while the grades of itching scores of N-2 group were better than those of N-1 group and N-3 group within 24 hours after operation（P>0.05）.（6）The overall incidence rates of adverse reactions such as nausea,vomiting,respiratory depression and itching in N-1 group,N-2 group and N-3 group within 24hours after operation were 13.33%,6.67%and 10.00%,respectively which were lower than 23.33%in P group.The overall incidence of adverse reactions was the lowest in N-2 group（P>0.05）.（7）The rates of supplementedmedication in N-1 group,N-2 group and N-3 group（10.00%,6.67%,6.67%）were lower than that in P group（33.33%）（P<0.05）,without significant differencebetween any two groups of N-1 group,N-2 group and N-3 group（P>0.05）.（8）PRL in N-1 group,N-2 group and N-3 group showed a increasing trend at 6h,12h and 24h after operation（P<0.05）.But PRL was higher in N-1 group,N-2 group and N-3 group thanP group at 6h,12h and 24h after operation.The PRL levels in N-2 group were higher than those inN-1 group and N-3group at 12h and 24h after operation（P<0.05）.（9）The PDSS scores of N-1 group,N-2group and N-3 group were lower than those of group P at 12h,24h and 48h after operation（P<0.05）,and PDSS scores ofN-2 group at 24h and 48h after operation were lower than those of N-1 group and N-3 group（P<0.05）.（10）The overall satisfaction of N-1 group,N-2 group and N-3 group was higher than that of group P,and the overall satisfaction of N-2 group was the highest（P<0.05）.Conclusion:Naproxine for postoperative analgesia after cesarean section can better inhibit maternal uterine contraction pain,reduce the pruritus caused by intrathecal morphine analgesia and other related adverse reactions,including 0.15 mg/kg of nalbuphine vein.The doses used were most pronounced in the comparison of the studies in each group.