低剂量纳布啡联合舒芬太尼在妇科腹腔镜手术术后镇痛中的应用

Application of Low-dose Nalbuphine Combined with Sufentanil in Analgesia after the Laparoscopic Surgery in the Department of Gynecology

目的观察妇科腹腔镜手术术后自控静脉镇痛(PCIA)中应用低剂量纳布啡联合舒芬太尼的镇痛效果及不良反应。方法选取2015年1月—2017年9月在该院接受腹腔镜手术治疗、采用全麻并于术后行PCIA的108例妇科患者,按镇痛处理方式不同随机均分为两组,每组54例,对照组予以舒芬太尼+盐酸格拉司琼+生理盐水,观察组在其基础上予以少量纳布啡,比较两组镇痛、镇静效果及不良反应。结果两组均取得较好术后镇痛镇静效果,观察组术后8 h[(1.97±0.92)分vs(3.06±1.12)分,t=5.526 3,P<0.01]、12 h[(1.47±0.62)分vs(2.84±1.10)分,t=7.972 9,P<0.01]、24 h[(1.03±0.15)分vs(1.98±1.01)分,t=6.836 9,P<0.01]的镇痛VAS评分及8 h[(2.21±0.41)分vs(3.74±0.62)分,t=15.125 9,P<0.01]、12 h[(2.14±0.54)分vs(2.85±0.53)分,t=6.895 5,P<0.01)]、24 h[(2.22±0.44)分vs(3.12±0.41)分,t=10.996 8,P<0.01)]镇静Ramsay评分均比对照组低。观察组术后呕吐(3.70%vs 16.67%,χ2=4.959 7,P<0.05)、呼吸抑制(3.70%vs 20.37%,χ~2=7.083 4,P<0.01)发生率较对照组低,差异有统计学意义。结论妇科腹腔镜手术术后自控静脉镇痛中应用低剂量纳布啡联合舒芬太尼能显著缓解患者疼痛,保持其良好镇静状态,降低不良反应,效果显著。

Objective To observe the effect and adverse reactions of low-dose nalbuphine combined with sufentanil in analgesia after the laparoscopic surgery in the department of gynecology.Methods 108 cases of gynecologic patients for aparoscopic surgery in our hospital and using PCIA after surgery under the general anesthesia from January 2015 to September 2017 and randomly divided into two groups with 54 cases in each according to different analgesia ways,the control group used the sufentanil+glaslasetron+physiological saline,while the observation group used the few nalbuphine on the basis of the control group,and the analgesic and sedative effects and adverse reactions were compared between the two groups.Results The analgesic and sedative effects of the two groups after surgery were better,and the VAS scores and Ramsay scores in 8 h,12 h and 24 h were in the observation group were respectively[(1.97±0.92)points vs(3.06±1.12)points,t=5.526 3,P<0.01],[(1.47±0.62)points vs(2.84±1.10)points,t=7.972 9,P<0.01],[(1.03±0.15)points vs(1.98±1.01)points,t=6.836 9,P<0.01]and[(2.21±0.41)points vs(3.74±0.62)points,t=15.125 9,P<0.01],[(2.14±0.54)points vs(2.85±0.53)points,t=6.895 5,P<0.01],[(2.22±0.44 vs(3.12±0.41)points,t=10.996 8,P<0.01],which were lower than those in the control group,and the incidence rates of vomiting and respiratory depression after surgery in the observation group were lower than those in the control group,[(3.70%vs 16.67%,χ2=4.959 7,P<0.05),(3.70%vs 20.37%,χ2=7.083 4,P<0.01),and the differences were statistically significant.Conclusion The application of low-dose nalbuphine combined with sufentanil in analgesia after the laparoscopic surgery in the department of gynecology can obviously relieve the pains,keep a good sedation state and reduce the adverse reactions,and the effect is obvious.