Analgesic efficacy of epidural self-controlled analgesia combined with nalbuphine in parturients with gestational diabetes mellitus after cesarean section
Objective To investigate the analgesic efficacy of epidural self-controlled analgesia combined with nalbuphine in parturients with gestational diabetes mellitus(GDM)after cesarean section.Methods A total of 182 parturients with GDM who underwent cesarean section from September 2019 to September 2023 in our hospital were selected and randomized into a control group and an observation group,with 91 in each group.The patients in both groups received epidural self-controlled analgesia.Meanwhile,the patients in the observation group were given nalbuphine hydrochloride injection and those in the control morphine hydrochloride injection.Fasting plasma glucose,heart rate,visual analogue scale(VAS)scores,prolactin(PRL),cortisol(Cor),and angiotensin Ⅱ(Ang Ⅱ)levels were compared before anesthesia and after operation in both groups.The dosage of analgesic drugs,the number of presses on the analgesic pump and the incidence of adverse reactions were also compared between the 2 groups.Results The blood glucose levels in the observation group[(T1:4.93±0.29,T2:4.87±0.24,T3:4.74±0.28,T4:4.53±0.31) mmol·L-1]were lower than those in the control[(T1:5.61±0.34,T2:5.55±0.37,T3:5.54±0.34,T4:5.62±0.31) mmol·L-1]at all time points postoperatively.The VAS scores[(T1:4.29±0.53,T2:2.65±0.36)points],Ang Ⅱ[(T1:51.38±5.91,T2:40.41±4.92) ng·L-1],and Cor[(T1:403.43±46.61,T2:324.51±39.17) ng·mL-1]levels in the observation group were lower than those in the control[VAS(T1:6.12±0.74,T2:4.82±0.54)points,Ang Ⅱ(T1:62.98±5.69,T2:52.19±6.95) ng·L-1,Cor(T1:571.38±62.39,T2:467.38±50.24) ng·mL-1]at the 6th and 12th h postoperatively.The prolactin levels in the observation group[(T1:248.73±9.69,T2:279.86±13.38,T3:291.86±11.46) mmol·L-1]were higher than those in the control[(T1:214.53±11.39,T2:224.53±13.42,T3:237.89±11.02) mmol·L-1]at the 6th,12th and 24th h postoperatively.The number of presses on the analgesic pump(11.42±1.97 times)and the drug dosage(61.21±7.13 mg)in the observation group were less than those in the control(24.11±2.78 times,82.58±9.15 mg),with statistically significant differences(P<0.05).The difference in the incidence rates of adverse reactions between the two groups(observation group:7.69%,control group:5.49%)was not statistically significant(P>0.05).Conclusion Epidural self-controlled analgesia combined with nalbuphine can effectively provide analgesia and sedation,promote lactation behavior and reduce stress response in parturients.Furthermore,it has high safety.
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