不同剂量纳布啡用于腹腔镜术后自控静脉镇痛效果及不良反应的比较

Comparison of analgesic effect and adverse reaction of nalbuphine at different doses in patient-controlled intravenous analgesia after laparoscopic surgery

目的观察纳布啡用于腹腔镜术后自控静脉镇痛(patient controlled intrarenous analgesia,PCIA)的效果,并探讨纳布啡的适宜镇痛剂量。方法选择行全麻腹腔镜手术患者120例,年龄18~70岁,体质量40~90 kg,ASA分级Ⅰ或Ⅱ级。采用随机数字表法分为4组(n=30):N1组,无自控静脉镇痛;N2组,纳布啡1.5 mg/kg;N3组,纳布啡2.0 mg/kg;N4组,纳布啡2.5 mg/kg;N2、N3、N4组将纳布啡和托烷司琼10 mg用0.9%生理盐水稀释至100 ml行术后PCIA,设置首剂量2 ml,维持量2 ml/h,PCA 1 ml/次,锁定时间15 min。观察患者术后2 h(T_1)、6 h(T_2)、12 h(T_3)、24 h(T_4)、36 h(T_5)的疼痛视觉模拟评分(VAS)、Ramsay镇静评分(RSS)、平均动脉压(MAP)、心率(HR)、皮肤瘙痒、恶心呕吐、眩晕、呼吸抑制、嗜睡情况。结果与N1组比较,其他三组在T_1、T_2、T_3、T_4、T_5时点的VAS评分、MAP、HR降低(P<0.05);与N2组比较,N3、N4组各时点的VAS评分、MAP、HR降低,RSS评分升高(P<0.05);N3与N4组比较,各时点间的VAS评分无统计学意义(P>0.05),但N3组的RSS评分、嗜睡等不良反应的总发生率低(P<0.05)。结论纳布啡2.0 mg/kg用于腹腔镜术后PCIA,镇痛效果好,舒适度高,不良反应发生率低。

Objective To investigate the appropriate analgesic dose of nalbuphine for patient-controlled intravenous analgesia(PCIA)after laparoscopic surgery.Methods The 120 cases subject to scheduled laparoscopic surgery were selected for general anesthesia,aged from 18 to 70 years old,body mass 40-90kg,ASAⅠorⅡgrade,and randomly divided into 4 groups(n=30):group N1,without patient-controlled intravenous analgesia;group N2,nalbuphine 1.5mg/kg;group N3,nalbuphine 2.0mg/kg;group N4,nalbuphine 2.5mg/kg;In the groups N2,N3 and N4,the nalbuphine and tropisetron were diluted to 100ml by 0.9%normal saline for PCIA,which was set up to deliver a 1ml bolus dose with a 15min lockout interval and background infusion at 2ml/h after a load dose of 2ml for 48hrs.The pain visual analogue scale(VAS),Ramsay sedation score(RSS),mean arterial pressure(MAP),heart rate(HR),pruritus,nausea and vomiting,vertigo,respiratory depression,drowsiness were observed at 2h(T1),6h(T2),12h(T3),24h(T4)and 36h(T5).Results Compared with group N1,the VAS scores,MAP and HR in the other three groups were decreased at the time of T1,T2,T3,T4 and T5(P<0.05).Compared with group N2,the VAS scores,MAP,HR of groups N3 and N4 were decreased,but the RSS score was increased(P<0.05).There was no significant difference in the VAS score between group N3 and group N4(P>0.05),but the RSS score,the drowsiness and the total incidence of adverse reactions in group N3 were lower(P<0.05).Conclusion The appropriate analgesic dose of naporphine for PCIA after laparoscopic surgery is 2mg/kg,which provides a satisfactory effect with less complication.