纳布啡联合舒芬太尼用于老年全髋关节置换术后镇痛镇静效果研究

Effect of Nalbuphine Combined with Sufentanil on Analgesia and Sedation after Total Hip Arthroplasty in Elderly Patients

目的探讨纳布啡联合舒芬太尼用于老年患者单侧全髋关节置换术后自控静脉镇痛(PCIA)的效果和安全性。方法选择骨科择期行单侧全髋关节置换术的老年患者120例,随机均分为纳布啡组(N组)、舒芬太尼组(S组)及纳布啡+舒芬太尼组(NS组)。术后分别接受PCIA治疗。观察患者术后1,4,8,12,24 h时的生命体征,比较各时点患者疼痛视觉模拟评分法(VAS)评分、Ramsay镇静评分、自控镇痛次数、镇痛效果及不良反应的发生率。结果 3组PCIA方案均能达到良好的镇痛、镇静效果,N组患者4,8,12,24 h的VAS评分明显高于S组和NS组(P<0.05),S组患者4,8,12 h时Ramsay镇静评分明显低于N组和NS组(P<0.05);4 h后,N组患者自控镇痛给药次数较S组和NS组明显增多,NS组患者镇痛满意度明显优于N组和S组(P<0.01);NS组患者头晕、恶心、呕吐等不良反应的总发生率明显低于N组和S组(P<0.01)。结论纳布啡复合舒芬太尼用于老年患者单侧全髋关节置换术后PCIA,镇痛效果强,舒适性高,不良反应少,值得临床推广。

Objective To explore the effect of nalbuphine combined with sufentanil on analgesia and sedation after total hip arthroplasty in elderly patients.M ethods 120 elderly patients undergoing elective total hip arthroplasty under orthopedic surgery were randomized to receive either nalbuphine（group N）,sufentanil（group S） or nalbuphine ＋ sufentanil（group NS）.The patients were followed up with patient-controlled analgesia（PCIA） treatment.The VAS score,the Ramsay sedation score,the number of patient-controlled analgesia,the analgesic effect and the side effects were compared between the two groups at 1,4,8,12 and 24 h postoperatively.The postoperative visual analogue scale Incidence.Results PCIA achieved a good analgesic,sedative effect in the 3 groups.The VAS scores of group N were significantly higher than those of group S and group NS at 4,8,12 and 24 h（P〈0.05）,and the Ramsay sedation scores of group S were significantly lower than those of group N and group NS at 4,8,and 12 h（P〈0.05）.After 4 h,the number of PICA in group N was significantly more than that in group S and group NS,and the analgesic satisfaction rate in group NS was significantly better than that in group N and group S（P〈0.01）.The total incidence rate of adverse reactions such as dizziness,nausea and vomiting in group NS was significantly lower than that in group N and group S（P〈0.01）.Conclusion Nalbuphine combined with sufentanil for elderly patients with unilateral total hip arthroplasty after PCIA has good analgesic effect,high comfort,and less adverse reactions.