鞘内注射纳布啡与芬太尼在胫骨骨折开放固定术中的镇痛效果

Analgesic effect of intrathecal nalbuphine and fentanyl as adjuvant in surgery for tibial fracture

目的研究两种不同剂量纳布啡和芬太尼在胫骨骨折开放固定术中的镇痛效果。方法选择腰麻下行胫骨骨折开放固定术患者90例，随机分为三组，每组30例，0.5%的重比重左布比卡因2 ml分别联合0.5 μg/ml芬太尼25 μg（F组）、0.5 mg/ml纳布啡0.8 mg（NL组）、0.5 mg/ml纳布啡1.6 mg（NH组）。观察不同时间间隔内直至阻滞后24 h各组感觉和运动阻滞特点、镇痛持续时间、VAS评分、不良反应。结果三组运动阻滞特点和镇痛持续时间比较差异未见统计学意义（P〉0.05）。VAS评分最低为NL组，最高为F组，差异有统计学意义（P〈0.05）；NL组的不良反应最少。结论与低剂量0.8 mg的纳布啡比较，鞘内注射芬太尼或1.6 mg的纳布啡无明显临床优势，前者更具临床应用价值。

Objective To compare the analgesic efficacy of fentanyl and two doses of nalbuphine in surgery for tibial fracture. Methods A total of 90 patients with open tibial fracture fixation under spinal anesthesia were randomly divided into three groups （n = 30）, 0. 5 % heavy gruvity bupivacaine 2 ml combined with 0. 5 μg/ml fentanyl 25μg （ group F）, 0.5 mg/ml nalbuphine 0. 8 mg （ group NL ）, 0. 5 mg/ml nalbuphine 1.6 mg （group NH）. Sensory and motor block characteristics, duration of analgesia,VAS score, adverse effects at different time interval ied. Results There was no significant difference in intraoperatively and till 24 hours of block were stud- characteristics of motor block or duration of analgesia （P 〉 0. 05 ）. The lowest VAS score was in group NL and the highest was in group F, the difference was significant （P 〈 0. 05 ）. The group NL had the least adverse reactions. Conclusions The intrathecal fentanyl or 1.6 mg nalbuphine compared with low dose 0. 8 mg nalbuphine, there was no obvious clinical advantages, the former is more valuable in clinical practice.