盐酸纳布啡对小儿胃镜检查中丙泊酚注射痛的影响

Effect of nalbuphine on preventing propofol-induced pain in children undergoing gastroscopy

目的探讨麻醉诱导前静脉注射盐酸纳布啡对小儿胃镜检查时丙泊酚注射痛的预防效果。方法行胃镜检查患儿120例,随机分为对照组、盐酸纳布啡组、利多卡因丙泊酚混合组(混合组)各40例。对照组和盐酸纳布啡组麻醉诱导前分别静脉注射生理盐水、盐酸纳布啡0.2mg/kg,5min后静脉注射丙泊酚18mL+生理盐水2mL;混合组麻醉诱导前静脉注射生理盐水,5min后静脉注射丙泊酚18mL+质量分数1%利多卡因2mL,待患者睫毛反射消失后停止注射丙泊酚,胃镜检查中体动反应明显时追加丙泊酚0.3mg/kg。采用Ambesh四分法进行疼痛评分,比较3组患儿胃镜检查中注射痛发生率、丙泊酚用量、复苏时间、不良事件发生率。结果盐酸纳布啡组患儿注射痛发生率(7.5%)、丙泊酚用量[(2.0±1.5)mg/kg]和检查时体动和呛咳发生率(5.0%)明显低于对照组[52.5%、(2.6±2.2)mg/kg、45.0%]和混合组[35.0%、(2.5±2.3)mg/kg、25.0%]),混合组低于对照组(P<0.05);盐酸纳布啡组患儿复苏后嗜睡发生率(20.0%)明显高于对照组(2.5%)和混合组(5.0%)(P<0.05),复苏时间[(18.1±6.3)min]及低血压、窦性心动过缓、呼吸抑制发生率(5.0%、2.5%、2.5%)与对照组[(17.5±5.3)min、5.0%、7.5%、5.0%]和混合组[(17.1±6.8)min、2.5%、2.5%、2.5%]比较差异无统计学意义(P>0.05)。结论麻醉诱导前静脉注射盐酸纳布啡0.2mg/kg可有效预防小儿胃镜检查时丙泊酚注射痛,减少胃镜检查中丙泊酚用量,且不影响患儿苏醒时间,但术后易发生嗜睡。

Objective To observe the effect of intravenous injection of nalbuphine before aneasthetic induction on preventing propofol-induced pain in children undergoing gastroscopy. Methods Totally 120 children scheduled for gastroscopy were randomly divided into control group, nalbuphine group and mixed group, with 40 children in each group. Control group received intravenously injection of normal saline and nalbuphine group received intravenously injection of 0.2 mg/kg 5 min before intravenously injection of 18 mL propofol ＋ 2 mL normal saline, whereas mixed group received intravenously injection of normal saline before intravenously injection of 18 mL propofol ＋ 2 mL 1% lidocaine. Ambesh four-point scale was used to evaluate the pain degree. The incidence of propofol-induced pain, propofol dose, resuscitation time and adverse reaction rate. Results The incidence of propofol-induced pain, the propofol dose, and body movement were significantly lower in nalbuphine group （7.5%, （2.0-±1.5） mg/kg, 5.0%） than those in control group （52.5%, （2.6±2.2）mg/kg, 45.0%）and mixed group （35.0%, （2.5±2.3） mg/kg, 25.0%）, and in mixed group than those in control group （P〈0.05）. The incidence of somnolence after resuscitation was significantly higher in nalbuphine group （20.0%） than that in control group （2.5%） and mixed group （5.0%） （P〈0.05）, and there were no significant differences in the resuscitation time, and the incidences of hypotension, sinus bradycardial and respiratory depression in nalbyphine group （（18.1± 6.3） min, 5.0%, 2.5%, 2.5%） compared with those in control group （（17.5±5.3） min, 5.0%, 7.5%, 5.0%） and mixed group （（17. 1±6.8） min, 2.5%, 2.5%, 2.5%） （P〉 0.05）. Conclusion Intravenous injection of 0.2 mg/kg nalbuphine before aneasthetic induction can effectively prevent propofol-induced pain and reduce the propofol dose in children undergoing gastroscopy without prolonging the resuscitation time, but somnolence usually occurs after resuscitation.