纳布啡、舒芬太尼联合氟比洛芬酯在腹腔镜子宫切除术后自控静脉镇痛中对疼痛介质释放的影响

Effect of nalbuphine and sufentanil combined with flurbiprofen axetil on the release of pain mediators during PCIA after laparoscopic hysterectomy

摘要:

目的 观察纳布啡、舒芬太尼联合氟比洛芬酯在腹腔镜子宫切除术后自控静脉镇痛（PCIA）中对疼痛介质释放的影响。方法 选取2020年2月—2023年2月在呼和浩特市第一医院行腹腔镜子宫切除术的98例患者为研究对象，采用简单随机法分为舒芬太尼组和纳布啡组，每组49例。舒芬太尼组术后给予舒芬太尼2.0 μg/kg +氟比洛芬酯2.0 mg/kg进行PCIA干预，纳布啡组术后给予纳布啡2.0 mg/kg +氟比洛芬酯2.0 mg/kg进行PCIA干预。记录两组≤ 24 h和24～48 h患者PCIA按压有效次数，统计两组补救镇痛率、不良反应率，记录两组止吐药追加剂量，评估两组运动和静息状态下VAS评分、Ramsay镇静评分，检测两组手术切口周围机械性痛阈值、应激反应、疼痛介质水平。结果 纳布啡组≤ 24 h和24～48 h的PCIA按压有效次数均少于舒芬太尼组（P <0.05）；补救镇痛率低于舒芬太尼组（P <0.05）。纳布啡组与舒芬太尼组术后4、8、12、24和48 h运动和静息状态下VAS评分、Ramsay镇静评分、手术切口周围机械性痛阈值比较，结果 ①不同时间点运动和静息状态下VAS评分、手术切口周围机械性痛阈值比较，差异均有统计学意义（P <0.05）；不同时间点Ramsay镇静评分比较，差异无统计学意义（P >0.05）；②纳布啡组与舒芬太尼组运动和静息状态下VAS评分、Ramsay镇静评分、手术切口周围机械性痛阈值比较，差异均有统计学意义（P <0.05）；③纳布啡组与舒芬太尼组运动和静息状态下VAS评分、Ramsay镇静评分、手术切口周围机械性痛阈值变化趋势比较，差异均有统计学意义（P <0.05）。纳布啡组与舒芬太尼组术前及术后24、48 h应激反应、疼痛介质比较，结果 ①不同时间点皮质醇（Cor）、血糖（Glu）、去甲肾上腺素（NE）、P物质（SP）、神经肽Y（NPY）、前列腺素E2（PGE2）比较，差异均有统计学意义（P <0.05）；②纳布啡组与舒芬太尼组Cor、Glu、NE、SP、NPY、PGE2比较，差异均有统计学意义（P <0.05）；③纳布啡组与舒芬太尼组Cor、Glu、NE、SP、NPY、PGE2变化趋势比较，差异均有统计学意义（P <0.05）。纳布啡组恶心、呕吐发生率均低于舒芬太尼组（P <0.05）。两组嗜睡、寒战、躁动发生率比较，差异均无统计学意义（P >0.05）。纳布啡组止吐药追加剂量低于舒芬太尼组（P <0.05）。结论 腹腔镜子宫切除术后应用纳布啡联合氟比洛芬酯进行镇痛可抑制机体应激反应和疼痛介质的释放，提高机械性痛阈值，减轻术后疼痛，减少术后恶心、呕吐的发生。

关键词:子宫切除;自控静脉镇痛;纳布啡;氟比洛芬酯;疼痛介质;机械性痛阈值

Abstract:

Objective To observe the effect of nalbuphine and sufentanil combined with flurbiprofen axetil on the release of pain mediators during patient controlled intravenous analgesia (PCIA) after laparoscopic hysterectomy.Methods Ninety-eight patients who undergoing laparoscopic hysterectomy in The First Hospital of Hohhot from February 2020 to February 2023 were included and divided into the sufentanil group and the nalbuphine group by simple random sampling, with 49 cases in each group. The sufentanil group was given 2.0 μg/kg of sufentanil plus 2.0 mg/kg of flurbiprofen axetil for PCIA, and the nalbuphine group was given 2.0 mg/kg of nalbuphine plus 2.0 mg/kg of flurbiprofen axetil for PCIA. The number of effective PCIA intervention within 24 h and between 24 h and 48 h postoperatively in the two groups was recorded. The rate of rescue analgesia, incidence of adverse reactions, and the additional dose of antiemetic drugs in the two groups were also recorded. Patients in the two groups were evaluated via the visual analog scale at rest and on motion as well as the ramsay sedation scale. The mechanical pain threshold around the surgical incision, stress response and levels of pain mediators were detected in the two groups.Results The number of effective PCIA intervention within 24 h and between 24 h and 48 h in the nalbuphine group was lower than that in the sufentanil group (P < 0.05). The rate of rescue analgesia in the nalbuphine group was also lower than that in the sufentanil group (P < 0.05). The VAS scores at rest and on motion, the Ramsay Sedation Scale scores, and the mechanical pain threshold around the surgical incision 4 h, 8 h, 12 h, 24 h and 48 h after the surgery in the two groups were compared. The results revealed that VAS scores at rest and on motion and the mechanical pain threshold around the surgical incision but not the Ramsay Sedation Scale scores were different among the time points (P < 0.05), and that all of them and the change trends thereof were different between the two groups (P < 0.05). The stress response and the levels of pain mediators before and 24 h and 48 h after the surgery were compared between the nalbuphine group and the sufentanil group, which demonstrated that there were differences in the levels of cortisol (Cor), blood glucose (Glu), norepinephrine (NE), substance P (SP), neuropeptide Y (NPY) and prostaglandin E2 (PGE2) among different time points and between the two groups (P < 0.05), and that the change trends of these indicators were different between the two groups (P < 0.05). The incidence of nausea and vomiting in the nalbuphine group was lower than that in the sufentanil group (P < 0.05). There was no significant difference in the incidence of drowsiness, chills and agitation between the two groups (P > 0.05). The additional dose of antiemetics in the nalbuphine group was lower than that in the sufentanil group (P < 0.05).Conclusions Nalbuphine combined with flurbiprofen axetil for analgesia after laparoscopic hysterectomy could inhibit the stress response and the release of pain mediators, increase the mechanical pain threshold, reduce postoperative pain, and lower the incidence of postoperative nausea and vomiting.

Key words:hysterectomy;patient-controlled intravenous analgesia;nalbuphine;flurbiprofen axetil;pain mediators;mechanical pain threshold