Abstract: Objective　To compare the clinical efficacies and safety of intravenous nalbuphine and remifentanil combined with epidural block in labor analgesia. Methods　A total of 150 full-term puerperae at Third Affiliated Hospital of Guangzhou Medical University from August to October 2020 were randomly divided into a simple epidural analgesia group (group C), a nalbuphine adjuvant epidural analgesia group (group N), and a remifentanil adjuvant epidural analgesia group (group R), with 50 cases in each group. All the three groups received epidural labor analgesia when their uterine orifices were opened to 3 cm. Within 10 minutes before the epidural puncture, group N was given intravenous injection of nalbuphine 0.1 mg/kg, and group R was given intravenous injection of remifentanil 0.20 μg/kg, then continuous intravenous infusion of remifentanil 0.05 μg/kg·min^-1 until the anesthesia level reached T10 and the infusion was stopped. All the three groups was given 0.065% ropivacaine + 0.4 μg/ml sufentanil epidural continuous infusion. The scores of Visual Analogue Scale (VAS) were recorded before analgesia, at epidural puncture, and each time point after analgesia. The duration of labor, the rate of cesarean section, the rate of instrumental-assisted labor, the utilization rate of oxytocin, and the maternal satisfaction were recorded. The neonates' Apgar scores (1, 5, and 10 min) were recorded, and their umbilical artery blood was extracted for blood gas analysis. The adverse reactions during delivery were observed. The independent-sample t, paired t, and χ² tests were applied. Results　The VAS scores at epidural puncture in group N and group R were significantly lower than that in group C [(5.68±1.13) and (5.61±1.11) vs. (8.10±1.00)], with statistical differences between group N and group C and between group R and group C (both P<0.05) but no between group N and group R (P>0.05). The scores of maternal satisfaction in group N and group R were higher than that in group C [(9.04±0.86) and (9.36±0.74) vs. (8.47±0.84)], with statistical differences between group N and group C and between group R and group C (both P<0.05) but no between group N and group R (P>0.05). The Ramsay sedation scores at epidural puncture in group N and group R was higher than that in group C [(1.75±0.43) and (2.17±0.60) vs. (1.17±0.38)], with statistical differences (both P<0.05). The incidences of dizziness in group N and group R were higher than that in group C [32% (16/50) and 40% (20/50) vs. 12% (6/50)], with statistical differences between group N and group C and between group R and group C (both P<0.05) but no between group N and group R (P>0.05). The incidence of narcolepsy in group R was 10% (5/50), which was statistically different from those in group N (0) and group C (0) (both P<0.05). There were no statistical differences in general data, VAS scores at other time points, improved Bromage scores at all the time points, time of labor, cesarean section rate, instrumental delivery rate, oxytocin utilization rate, Apgar score of newborns, and umbilical artery blood gas analysis between the three groups (all P>0.05). Conclusion　Intravenous infusion of small doses of nalbuphine and remifentanil can significantly relieve the pain level before epidural labor analgesia takes effect and alleviate maternal tension, so that the puerperae can better cooperate with the anesthesiologists' instructions, create more favorable conditions for the anesthesia operation, improve their satisfaction, do not affect the delivery mode, do not prolong the labor process, and do not increase the occurrence of maternal and infant serious adverse reactions.

Key words: Nalbuphine, Remifentanil, Epidural block, Labor analgesia

摘要： 目的　比较静脉输注纳布啡与瑞芬太尼辅佐硬膜外阻滞应用于分娩镇痛的临床效果和安全性。方法　选择2020年8月至10月广州医科大学附属第三医院足月初产妇150例，按照简单随机数字表法分为单纯硬膜外镇痛组（C组）、纳布啡辅佐硬膜外镇痛组（N组）和瑞芬太尼辅佐硬膜外镇痛组（R组），每组50例。3组均待宫口开至3 cm时行硬膜外阻滞分娩镇痛。在行硬膜外穿刺前10 min内，N组予纳布啡0.1 mg/kg静脉注射，R组予首量瑞芬太尼0.2 μg/kg静脉注射后予瑞芬太尼［0.05 μg/（kg·min）］静脉持续泵注至麻醉平面达到T10时停止泵注。3组均予0.065%罗哌卡因+0.4 μg/ml舒芬太尼硬膜外持续泵注。记录镇痛前、硬膜外穿刺即刻、镇痛后各时间点产妇疼痛视觉模拟评分法（VAS）的评分；记录产程时间、剖宫产率、器械助产率、缩宫素使用率、产妇满意度；记录新生儿Apgar评分（1 min、5 min、10 min），抽取脐动脉血行血气分析；观察分娩过程中的不良反应。统计学方法采用独立样本t检验、配对t检验、χ²检验。结果　N组和R组硬膜外穿刺即刻VAS评分均明显低于C组［（5.68±1.13）分、（5.61±1.11）分比（8.10±1.00）分］，差异均有统计学意义（均P<0.05），但N组和R组比较差异均无统计学意义（均P>0.05）；N组和R组产妇满意度评分均较C组升高［（9.04±0.86）分、（9.36±0.74）分比（8.47±0.84）分］（均P<0.05），但N组和R组对比无差异；N组和R组硬膜外穿刺即刻Ramsay镇静评分均高于C组［（1.75±0.43）分、（2.17±0.60）分比（1.17±0.38）分］，差异均有统计学意义（均P<0.05）；N组和R组头晕发生率均较C组升高［32.0%（16/50）、40.0%（20/50）比12.0%（6/50）］（均P<0.05），但N组和R组对比无差异；R组嗜睡发生率为10.0%（5/50），与发生率均为0的N组和C组比较差异均有统计学意义（均P<0.05）。3组产妇一般资料、产程时间、剖宫产率、器械助产率、缩宫素使用率、其他时间点VAS评分、改良Bromage评分及所有时间点的Ramsay镇静评分、新生儿Apgar评分、脐动脉血气分析比较差异均无统计学意义（均P>0.05）。结论　静脉输注小剂量纳布啡、瑞芬太尼可以明显缓解硬膜外分娩镇痛起效前的疼痛程度，缓解产妇的紧张情绪，令其可以更好地配合麻醉医师指令，为麻醉操作创造更有利的条件，提高产妇满意度，同时不影响分娩方式、不延长产程、不增加母婴严重不良反应的发生。

关键词: 纳布啡, 瑞芬太尼, 硬膜外阻滞, 分娩镇痛