纳布啡在腹腔镜胆囊切除术预防性镇痛中的疗效分析

Effects of nalbuphine preventive analgesia on postoperaive pain in patients undergoing laparoscopic cholecystectomy

摘要:

目的 观察纳布啡预防性镇痛对腹腔镜胆囊切除术后患者疼痛、苏醒时间及拔管时间的影响。方法 选取2018年1月—2019年5月在徐州医科大学附属淮安医院全身麻醉下行腹腔镜胆囊切除手术的患者90例。按随机数字表法分为3组，每组30例。于术前15 min静脉注射，分为纳布啡0.1 mg/kg（N1组）、纳布啡0.2 mg/kg（N2组）和生理盐水5 ml（NS组）。分析比较3组麻醉苏醒时间、拔管时间及拔管后Ramsay评分，以及术后2 h（T₁）、4 h（T₂）、8 h（T₃）、24 h（T₄）、48 h（T₅）及72 h（T₆）静息状态下和活动时疼痛数字评分法（NRS）评分、补救镇痛用量及术后不良反应发生情况。结果 N2组苏醒时间、拔管时间较NS组减少（P <0.05）。3组T₁、T₂、T₃、T₄、T₅、T₆静息状态下和活动时NRS在不同时间、不同组间及变化趋势上有差异（P <0.05）。与NS比较，N2组术后首次补救镇痛时间延长（P <0.05），补救镇痛总量减少（P <0.05）。NS组恶心、呕吐等不良反应发生率高于N1组和N2组（P <0.05）。结论 纳布啡预防性镇痛能够有效缓解腹腔镜胆囊切除术后患者的疼痛，不良反应少，0.2 mg/kg较0.1 mg/kg纳布啡预防性镇痛效果更好。

Abstract:

Objective To investigate the effect of nalbuphine preventive analgesia on pain, recovery time, and extubation time after laparoscopic cholecystectomy.Methods Nighty patients underwent laparoscopic cholecystectomy under elective general anesthesia in our hospital were enrolled in our study. Patients were divided into three groups according to the random number table method, 30 cases in each group. Intravenous injection was administered 15 min before surgery: nalbuphine 0.1 mg/kg (N1 group), nalbuphine 0.2 mg/kg (N2 group) (each group dilute the drug with saline to 5 ml) or 5 ml of saline (NS group). We compared the recovery time, extubation time, Ramsay score after extubation and the NRS (Numerical Rating Score) on 2, 4, 8, 24, 48, and 72 h postoperatively between the three groups. The first rescue analgesia time, total rescue analgesia requirements and the adverse effects were also recorded.Results Compared with the controls, the patients of the N2 group showed significantly decreased in the recovery time and extubation time (P < 0.05). Compared with group NS, NRS (at rest and movement) of group N1, N2 were lower at 4, 8, 24, 48, 72 h postoperatively (P < 0.05). Group N2 showed lower NRS (at rest and movement) than group N1 at 4, 8, 24, 48, 72 h postoperatively. Compared with group NS, the first rescue analgesia time was significantly prolonged in the group N2 (P < 0.05), and the total amount of rescue analgesia requirements was significantly reduced (P < 0.05). The incidence of nausea and vomiting in the control group was significantly higher than that in the group N1 and the group N2 (P < 0.05).Conclusion Nalbuphine 0.1 mg/kg and nalbuphine 0.2 mg/kg preventive analgesia can effectively relieve pain in laparoscopic cholecystectomy (LC) patients with less adverse effects, and nalbuphine 0.2 mg/kg is more effective than nalbuphine 0.2 mg/kg.