不同剂量纳布啡联合芬太尼对腹腔镜子宫肌瘤挖除术患者术后镇痛的效果分析

Analgesic effect of different doses of nalbuphine combined with fentanyl by patient-controlled intravenous analgesia for patients after laparoscopic myomectomy

目的探讨纳布啡联合芬太尼用于腹腔镜子宫肌瘤挖除术患者的术后镇痛效果及适宜的配制剂量。方法选择2017年7-12月在我院行腹腔镜下子宫肌瘤挖除术,术后自愿要求行经静脉自控镇痛(patient controlled intravenous analgesia,PCIA)的患者160例,采用随机数字表法分为4组(n=40):纳布啡40 mg组(N_1组)、纳布啡60 mg组(N_2组)、纳布啡80 mg组(N_3组)、曲马多1 000 mg组(Q组),分别与芬太尼0.2 mg、昂丹司琼8 mg、地塞米松10 mg及生理盐水配制为100 m L镇痛泵液。比较4组患者术后6、24、48 h VAS评分、Ramsay评分、补救镇痛率及不良反应。结果术后各时间点VAS评分及补救镇痛率N_1组明显高于其余3组(P<0.05),而N_2、N_3、Q组间差异无统计学意义(P>0.05)。N_3组最高Ramsay评分及嗜睡发生率明显增高(P<0.05)。Q组术后恶心、呕吐发生率较高(P<0.05)。结论 60 mg纳布啡联合0.2 mg芬太尼PCIA用于腹腔镜下子宫肌瘤挖除术能取得满意的镇痛效果,且不良反应发生率低。

Objective To investigate the analgesic effect and optimum dose of nalbuphine combined with fentanyl prepared for patient-controlled intravenous analgesia（ PCIA） after laparoscopic myomectomy.Methods One hundred and sixty patients who had arranged PCIA after laparoscopic myomectomy in our hospital between July and December 2017 were randomly divided into 4 groups（ n = 40） ： 40 mg nalbuphine group（ N1）,60 mg nalbuphine group（ N2）,80 mg nalbuphine group（ N3） and 1 000 mg tramadol group（ Q）. The analgesic agents were respectively diluted with 0. 2 mg fentanyl,8 mg ondansetron and 10 mg dexamethasone together to 100 m L with normal saline for PCIA in each group. Ramsay sedation score,visual analog scale（ VAS） score at 6,24 and 48 h after surgery,ratio of those needing rescue analgesia,and adverse events were observed. Results The VAS scores at different time points and the ratio of those needing rescue analgesia were significantly higher in the group N1 than the other 3 groups（ P〈0. 05）,but there was no significant difference among the 3 groups（ P〉0. 05）. The N3 group had the highest Ramsay sedation score and increased incidence of somnolence（ P〈0. 05）,and the Q group had higher incidences of nausea and vomiting after operation（ P〈0. 05）. Conclusion Nalbuphine of 60 mg combined with 0. 2 mg fentanyl exerts satisfactory analgesic effect and has less adverse events for PCIA after laparoscopic myomectomy.