Objective  To investigate the effects of different doses of naloxone (NAL) administered on the puerpera and the newborn before intraspinal anesthesia.

Methods  The clinical data of women who underwent intraspinal labor analgesia at The Second Affiliated Hospital of Shantou University Medical College from August 2020 to June 2023 were analyzed. The patients were divided into three groups according to the dose of NAL given before intraspinal anesthesia: the control group (NAL 0 μg), the NAL-A group (NAL 40 μg), and the NAL-B group (NAL 80 μg). The observed indicators include the puerpera’s condition (VAS score, PCA button presses, labor duration, complication incidence), and the newborn's condition (weight, Apgar score, umbilical artery blood pH value, PCO₂ and PO₂).

Results  A total of 236 puerpera were included in the study, with 77 in the NAL-A group, 79 in the NAL-B group, and 80 in the control group. Maternal VAS scores and the number of PCA presses gradually decreased with the increasing NAL dose (P<0.05). The first stage of labor, the second stage of labor, and the incidence of adverse reactions in the NAL-B group were significantly lower than those of the NAL-A group and the control group (P<0.05). The weights of the newborns, Apgar scores, umbilical artery blood pH, PCO₂ and PO₂ were not statistically significant in the three groups (P>0.05).

Conclusion  80 μg NAL administered before intraspinal anesthesia is more effective, which can shorten the duration of labor, reduce the incidence of adverse effects, and has less effect on the newborn.

1.贾丽, 陈岱莉. 椎管内分娩镇痛对产程影响的研究进展 [J]. 中国临床新医学, 2021, 14(2): 209-213. [Jia  L, Chen  DL. Progress in the effect of intraspinal labor analgesia on labor process[J]. New Clinical Medicine in China, 2021, 14(2): 209-213.] DOI: 10.3969/j.issn.1674-3806.2021.02.21.

2.肖金凤. 电针联合椎管内麻醉分娩镇痛的可行性及机制研究[D]. 广州: 广州中医药大学, 2019. DOI: 10.27044/d.cnki.ggzzu.2019.000452.

3.张砡, 赵梦芸, 裴丽坚, 等. 分娩镇痛:舒适与安全并行,教学与质控并举[J]. 协和医学杂志, 2024, 15(2): 246-250. [Zhang Y, Zhao MY, Pei LJ, et al. Labor analgesia: comfort and safety are parallel, teaching and quality control are parallel[J]. Medical Journal of Peking Union Medical College Hospital, 2024, 15(2): 246-250.] DOI: 10.12290/xhyxzz.2024-0026.

4.刘波, 左云霞. 椎管内阻滞分娩镇痛相关产时发热的研究进展[J]. 临床麻醉学杂志, 2021, 37(12): 1314-1316. [Liu B, Zuo YX. Progress in intrapartum fever associated with intraspinal block labor analgesia[J]. Journal of Clinical Anesthesiology, 2021, 37(12): 1314-1316.] DOI: 10.12089/jca.2021.12.019.

5.云佳, 陈秀霞. 不同浓度罗哌卡因复合舒芬太尼硬膜外分娩镇痛的效果分析[J]. 数理医药学杂志, 2022, 35(6): 875-877. [Yun J, Chen XX. Analysis of the effect of epidural labor analgesia at different concentrations[J]. Journal of Mathematical Medicine, 2022, 35(6): 875-877.] DOI: 10.3969/j.issn.1004-4337.2022.06.027.

6.杨楠. 罗哌卡因复合舒芬太尼硬膜外麻醉对初产经阴道无痛分娩产妇产程和母婴结局的影响[J]. 数理医药学杂志, 2022, 35(4): 582-584. [Yang N. The effect of ropivacaine compound sufentanil epidural anesthesia on maternal labor process and maternal and infant outcomes during primary vaginal and painless delivery[J]. Journal of Mathematical Medicine, 2022, 35(4): 582-584.] DOI: 10.3969/j.issn.1004-4337.2022.04.036.

7.Lacassie HJ, Habib AS, Lacassie HP, et al. Motor blocking minimum local anesthetic concentrations of bupivacaine, levobupivacaine, and ropivacaine in labor[J]. Reg Anesth Pain Med, 2007, 32(4): 323-329. DOI: 10.1016/j.rapm.2007.05.003.

8.张琴, 韩志强, 段志强, 等. 罗哌卡因临床应用及神经毒性的新进展[J]. 河北医药, 2023, 45(12): 1872-1877. [Zhang Q, Han ZQ, Duan ZQ, et al. New advances in the clinical application and neurotoxicity of ropivacaine[J]. Hebei Medical Journal, 2023, 45(12): 1872-1877.] DOI: 10.3969/j.issn.1002-7386.2023.12.027.

9.周虎子威, 张云静, 于玥琳, 等. 机器学习方法在预测麻精药品不合理使用风险中的应用现状和思考[J]. 药物流行病学杂志, 2023, 32(4): 446-457. [Zhou  HZW, Zhang YJ, Yu YL, et al. Application status and thinking of machine learning methods in predicting the risk of irrational use of narcotic and psychotropic drugs[J]. Chinese Journal of Pharmacoepidemiology, 2023, 32(4): 446-457.] DOI: 10.19960/j.issn.1005-0698.202304010.

10.马俊丽, 魏新川. 阿片类受体拮抗剂预防全身麻醉术后恶心呕吐研究进展[J]. 临床军医杂志, 2021, 49(12): 1406-1408, 1410. [Ma JL, Wei XC. Progress in opioid receptor antagonists for prevention of nausea and vomiting after general anesthesia[J]. Clinical Journal of Medical Officers, 2021, 49 (12): 1406-1408, 1410.] DOI: 10.16680/j.1671-3826.2021.12.36.

11.Page S, Mavrikaki MM, Lintz T, et al. Behavioral pharmacology of novel kappa opioid receptor antagonists in rats[J]. Int J Neuropsychopharmacol, 2019, 22(11): 735-745. DOI: 10.1093/ijnp/pyz054.

12.朱梦雪, 刁怀悦, 修明宇. 小剂量纳洛酮联合全身麻醉对宫颈癌根治术患者苏醒质量及术后疼痛的影响[J]. 长春中医药大学学报, 2024, 40(5): 556-560. [Zhu MX, Diao HY, Xiu MY. Effect of low-dose naloxone combined with general anesthesia on awakening quality and postoperative pain in patients with radical cervical cancer[J]. Journal of Changchun University of Chinese Medicine, 2024, 40(5): 556-560.] DOI: 10.13463/j.cnki.cczyy.2024.05.020.

13.刘芳, 俞晨. 纳洛酮对老年患者无痛肠镜麻醉后苏醒质量和认知功能的影响[J]. 实用临床医药杂志, 2021, 25(9): 78-81. [Liu F, Yu C. Effect of naloxone on the quality of awakening and cognitive function after painless enteric anesthesia in elderly patients[J]. Journal of Practical Clinical Medicine, 2021, 25(9): 78-81.] DOI: 10.7619/jcmp.20210863.

14.张兴洋, 林宏正, 周健. 畲药地稔水煎液联合艾瑞昔布片对神经根型颈椎病的效果评估[J]. 中国药师, 2024, 27(3): 423-430. [Zhang XY, Lin HZ, Zhou J. Evaluation of the effect of the decoction combined with Arexib tablet on cervical radiculopathy[J]. Frontiers in Pharmaceutical Sciences, 27(3): 423-430.] DOI: 10.12173/j.issn.1008-049X.202401011.

15.贾晨, 屠晶佳, 华燕, 等. 曲安奈德治疗瘢痕疙瘩的临床分析[J]. 中国药师, 2023, 26(12): 400-405. [Jia C, Tu JJ, Hua Y, et al. Clinical analysis of triamcinolone for keloids[J]. Chinese Pharmacist, 2023, 26(12): 400-405.] DOI: 10.12173/j.issn.1008-049X.202311161.

16.施锦金, 张晶, 何晶. 间苯三酚对比地西泮对初产妇分娩效果的临床研究[J]. 中国药师, 2024, 27(7): 1178-1183. [Shi JJ, Zhang J, He J. Clinical study of the effect of diazepam on primiparous delivery[J]. Chinese Pharmacist, 2024, 27(7): 1178-1183.] DOI: 10.12173/j.issn.1008-049X.202406018.

17.吴宇, 徐毅明, 孙玉娥, 等. 罗哌卡因复合舒芬太尼或芬太尼在分娩镇痛中的效果[J]. 中国医药导报, 2023, 20(1): 115-118. [Wu Y, Xu YM, Sun YE, et al. Effect of ropivacaine to compound sufentanyl or fentanyl in labor analgesia[J]. China Medical Herald, 2023, 20(1): 115-118.] DOI: 10.20047/j.issn1673-7210.2023.01.26.

18.李莹, 宋振国, 张广华. 不同剂量纳洛酮联合地佐辛用于乳腺癌患者术后镇痛的效果[J]. 中国肿瘤临床, 2019, 46(2): 86-89. [Li Y, Song ZG, Zhang GH. Effect of different doses of naloxone combined with desoxoxin for postoperative analgesia in breast cancer patients[J]. Chinese Journal of Clinical Oncology, 2019, 46(2): 86-89.] DOI: 10.3969/j.issn.1000-8179.2019.02.386.

19.Van Lemmen M, Florian J, Li Z, et al. Opioid overdose: limitations in naloxone reversal of respiratory depression and prevention of cardiac arrest[J]. Anesthesiology, 2023, 139(3): 342-353. DOI: 10.1097/ALN.0000000000004622.

20.张庆婕, 刘斌, 钟伟芳. 催产素在物质成瘾治疗中的研究进展[J]. 中国药物依赖性杂志, 2023, 32(6): 501-505, 525. [Zhang QJ, Liu B, Zhong WF. Progress in oxytocin in the treatment of substance addiction[J]. Chinese Journal of Drug Dependence, 2023, 32(6): 501-505, 525.] DOI: 10.13936/j.cnki.cjdd1992.2023.06.002.

21.李丽, 张丽萍. 导乐分娩镇痛仪在产程中应用对母婴的影响[J]. 护理研究, 2019, 33(8): 1437-1439. [Li  L, Zhang  LP. The effect of labor analgesia instrument in labor on mother and baby[J]. Nursing Research, 2019, 33(8): 1437-1439.] DOI: 10.12102/j.issn.1009-6493. 2019.08.043.

22.谢丽萍, 王胜, 殷姜文, 等. 联合应用小剂量纳洛酮在剖宫产术后镇痛中的效果观察[J]. 中国现代医药杂志, 2016, 18(5): 4-7. [Xie LP, Wang S, Yin JW, et al. Combining the effect of small-dose naloxone in analgesia after cesarean section[J]. Modern Medicine Journal of China, 18(5): 4-7.] DOI: 10.3969/j.issn.1672- 9463.2016.05.002.

23.Firouzian A, Gholipour Baradari A, Ehteshami S, et al. The effect of ultra-low-dose intrathecal naloxone on pain intensity after lumbar laminectomy with spinal fusion: a randomized controlled trial[J]. J Neurosurg Anesthesiol, 2020, 32(1): 70-76. DOI: 10.1097/ANA.0000000000000537.