不同剂量纳布啡联合舒芬太尼用于妇科手术患者硬膜外术后镇痛疗效比较

Efficacy comparison of combination of different doses of nalbuphine and sufentanil in epidural analgesia after gynecological surgery

目的比较不同剂量纳布啡联合舒芬太尼用于妇科手术患者硬膜外术后镇痛的疗效。方法选择2016年10月至2017年7月铜陵市人民医院在腰硬联合麻醉下行择期妇科手术的患者80例,ASAⅠ~Ⅱ级,术后均行硬膜外持续镇痛,随机分为对照组(C组)、N1组、N2组、N3组,每组20例。C组给予舒芬太尼1.5μg/kg+氯普鲁卡因1.3 g,N1、N2、N3组分别给予0.2、0.4和0.8 mg/kg纳布啡+舒芬太尼1.5μg/kg+氯普鲁卡因1.3 g。比较患者术后6、8、12、24和48小时的镇痛效果、疼痛视觉模拟评分(VAS)、Ramsay评分及恶心、呕吐等不良反应的发生率。结果 4组患者镇痛、镇静效果均良好,差异无统计学意义(P>0.05)。N1、N2、N3组患者的术后总体满意度优于C组,差异有统计学意义(P<0.05),且N2组不良反应的发生率低于N1、N3组。结论 0.4 mg/kg纳布啡联合1.5μg/kg舒芬太尼用于妇科手术患者术后硬膜外镇痛效果满意,不良反应发生率低。

ObjectiveTo investigate the effects of different doses of nalbuphine combined with sufentanil for epidural analgesia after gynecological surgery MethodsEighty female patients(ASAⅠ~Ⅱ)were enrolled in the study,and they underwent gynecological surgery with combined spinal-epidural anesthesia(CSEA)Epidural analgesia was adopted after operation The patients were randomly divided into four groups(C,N1,N2,N3),with20cases in each group Group C was treated with sufentanil(1.5μg/kg)+choloroprocaine(1.3g),and group N1,N2or N3were treated with nalbuphine(0.2,0.4or0.8mg/kg)+sufentanil(1.5μg/kg)+choloroprocaine(1.3g)At6,8,12,24and48h after analgesia,visual analogue scale(VAS)scores,Ramsay sedation scores and the incidence rates of adverse reactions were observed in four groups at6,8,12,24and48h ResultsAll groups of formula could provide patients with good postoperative analgesia,and there were no significant difference between the four groups(P>0.05)The overall postoperative satisfaction of patients in Group(N1,N2,N3)was significantly better than that in group C(P<0.05)The incidence rates of adverse reactions in group N2were significantly lower than those in group N1and group N2ConclusionThe combination of nalbuphine(0.4mg/kg)and sufentanil in epidural analgesia is effective,with low incidence of opioid-related side effects