Effects Of Nalbuphine Combined With Ropivacaine The Anethesia Of Spinal-epidural On Plasma ACTH And COR Levels In Patients With Labor Analgesia

Objective:To observe the analgesic effect of nalbuphine and ropivacaine withcombined spinal-epidural anesthesia in labor analgesia,the regulation of maternal stress response,and its side effects,and to further clarify the safety and effectiveness of nalbuphine and ropivacaine in combined spinal-epidural anesthesia.Methods:In Xinyu Hospital of Traditional Chinese Medicine and De’an Hospital of Traditional Chinese Medicine,from January 2019 to November 2021,114women who met the inclusion conditions were divided into the control group（57patients）and the study group（57 patients）by random digital grouping.Lumbar anesthesia combined with epidural anesthesia was used for labor analgesia in both groups.The control group received sufentanil injection and ropivacaine injection.Spinal medication:sufentanil injection 1.5-2.0μg,ropivacaine injection 3-4mg,cerebrospinal fluid diluted to 3-4ml;Epidural medication:0.5μg/ml sufentanil+0.1%ropivacaine+0.9%Na Cl 100ml.Nalbuphine injection and ropivacaine injection were used in the study group.Spinal medication:nalbuphine injection 0.6-0.8mg,ropivacaine injection 3-4mg,cerebrospinal fluid diluted to 3-4ml;Epidural medication:0.1%ropivacaine+0.2mg/ml nalbuphine injection+0.9%Na Cl 100ml.Patient-controlled analgesia pump（PCEA）parameters of the two groups were as follows:first dose 10ml,duration 4-6ml/h,PCA dose 7-8ml/h,PCA interval 30min.Observation:Visual analogue scale（VAS）:immediately before analgesia（T₀）,15min after injection（T₁）,30min after injection（T₂）,and when the cervix was completely opened（T₃）,at the time of delivery（T₄）,2 hours after delivery（T₅）;Plasma levels of adrenocorticotropic hormone（ACTH）and cortisol（Cor）;Neonatal neurobehavioral score（NABA）at 24 hours after birth,and the incidence of adverse reactions in the two groups were recorded.Results:There was no significant difference in VAS at T0 between the two groups（P>0.05）.Compared with the control group T₁（3.02±0.38）,T₂（4.68±0.31）,T₃（5.04±0.37）and T₄（3.61±0.29）,the VAS of the study group was lower at T₁（2.03±0.35）,T₂（4.57±0.33）,T₃（4.57±0.33）,T₄（3.26±0.19）,and the differences were statistically significant（P<0.05）.There was no significant difference in T₅time points between the two groups（P>0.05）.The levels of ACTH and Cor in both groups decreased at 2h after fetal delivery.The ACTH（10.20±4.26 pg/ml）and Cor（35.24±6.08μg/l）in the study group were significantly lower than those in the control group（15.88±5.33）and Cor（40.87±9.05）（P<0.05）.There was no significant difference in NABA between the two groups（P>0.05）.The incidence of adverse reactions in the study group was 5.26%,which was significantly lower than 17.54%in the control group（P<0.05）.Conclusion:Nalbuphine and ropivacaine used for lumbar epidural labor analgesia has the advantages of rapid onset of analgesia,complete analgesia effect,favorable control of stress level,and no obvious side effects on the safety of puerpera and newborns.