纳布啡抑制宫腔镜手术患者喉罩置入反应半数有效剂量的研究及其临床应用

Study on the median effective dose of nalbuphine in inhibiting responses to laryngeal mask airway insertion in patients undergoing hysteroscopy and its clinical application

摘要:

目的 探讨纳布啡用于抑制宫腔镜手术患者在喉罩置入过程中反应的半数有效剂量（ED50），并比较纳布啡与舒芬太尼在麻醉诱导中的效果和安全性。方法 前瞻性选取2020年3月—2023年2月电子科技大学医学院附属妇女儿童医院接受宫腔镜手术的患者134例为研究对象。采用随机数字表法将患者分为剂量组、纳布啡组与舒芬太尼组，分别有45、44和45例。剂量组患者进行丙泊酚静脉泵注，初始剂量为0.2 mg/kg，持续5 min，置入喉罩。采用序贯法研究纳布啡抑制宫腔镜手术患者喉罩置入反应的ED50。当患者出现阳性反应时，下一个患者采用上一患者1.1倍浓度进行纳布啡静推。计算丙泊酚+纳布啡抑制宫腔镜手术患者喉罩置入反应的ED50。以ED50为参考进行对比。纳布啡组在宫腔镜手术中接受纳布啡+丙泊酚麻醉诱导。舒芬太尼组接受舒芬太尼+丙泊酚麻醉诱导。比较纳布啡组与舒芬太尼组麻醉前（T₀）、睫毛反射消失时（T₁）、术中（T₂）、手术结束即刻（T₃）血压、心率、血氧饱和度水平。比较纳布啡组与舒芬太尼组接受麻醉时丙泊酚的剂量及时间，统计纳布啡组与舒芬太尼组麻醉安全性及麻醉苏醒时的躁动状况。结果 纳布啡在宫腔镜手术中ED50 = 0.146（95% CI：0.126，0.166），ED95 = 0.165（95% CI：0.155，0.218）。纳布啡组术后苏醒时间、自主呼吸恢复时间均较舒芬太尼组短（P <0.05）。两组患者术后拔管时间的比较，差异无统计学意义（P >0.05）。纳布啡组丙泊酚诱导剂量、维持剂量均较舒芬太尼组少（P <0.05），给药时间较舒芬太尼组短（P <0.05）。纳布啡组不良反应总发生率低于舒芬太尼组（P <0.05）。结论 本研究确定了纳布啡在抑制宫腔镜手术患者喉罩置入反应时的ED50为0.146 mg/kg。两种药物在维持生命体征的稳定性方面效果相似，但纳布啡在控制术后疼痛方面表现更佳。

Abstract:

Objective To determine the median effective dose (ED50) of nalbuphine in inhibiting responses to laryngeal mask airway insertion in patients undergoing hysteroscopy, and to compare the efficacy and safety of nalbuphine with those of sufentanil in anesthesia induction.Methods A total of 134 patients who underwent hysteroscopy at our hospital from March 2020 to March 2023 were prospectively selected for the study. Patients were randomly assigned into a dose group (n = 45), a nalbuphine group (n = 44), and a sufentanil group (n = 45) using a random number table. Patients in the dose group were given intravenous pumping of propofol with an initial dosage of 0.2 mg/kg for 5 min, followed by laryngeal mask airway insertion. The sequential method was used to study the median effective dose of nalbuphine to inhibit the response to laryngeal mask placement in patients undergoing hysteroscopic surgery. The sequential method was used to study the ED50 of nalbuphine in inhibiting responses to laryngeal mask airway insertion in patients undergoing hysteroscopy. When a patient exhibited a positive response, the dose for the next patient was adjusted to 1.1 times the previous dose. The ED50 of nalbuphine plus propofol in inhibiting responses to laryngeal mask airway insertion was calculated, and the comparison was conducted based on the ED50. Patients in the nalbuphine group received nalbuphine plus propofol for anesthesia induction, while those in the sufentanil group received sufentanil plus propofol for anesthesia induction. The blood pressure, heart rate, and oxygen saturation of patients in the nalbuphine group and the sufentanil group before anesthesia (T₀), at the time of disappearance of the eyelash reflex (T₁), during the operation (T₂), and immediately after the operation (T₃). The dose of propofol and the duration of propofol use were compared between the nalbuphine group and the sufentanil group, and the safety of anesthesia and the agitation during recovery from anesthesia in the two groups of patients were analyzed.Results The ED50 of nalbuphine in hysteroscopy was 0.146 (95% CI: 0.126, 0.166), with the ED95 being 0.165 (95% CI: 0.155, 0.218). The patients in the nalbuphine group had shorter postoperative awakening time and recovery time for spontaneous breathing (P < 0.05). There was no difference in the postoperative extubation time between patients in the sufentanil group and those in the nalbuphine group as analyzed by the t-test (P > 0.05). Compared with the sufentanil group, the induction and maintenance doses of propofol were lower (P < 0.05) and the administration time of propofol was shorter in the nalbuphine group (P < 0.05). The overall incidence of adverse reactions was lower in the nalbuphine group than in the sufentanil group (P < 0.05).Conclusions This study establishes the ED50 of nalbuphine in inhibiting responses to laryngeal mask airway insertion in patients undergoing hysteroscopy as 0.146 mg/kg. Both drugs were similar in maintaining the stability of vital signs, but nalbuphine performs better in controlling postoperative pain than sufentanil does. Future researches should further explore the efficacy and safety of nalbuphine in different types of surgery and patient populations.