纳布啡复合舒芬太尼不同剂量组合用于腹式子宫切除术后镇痛的观察

Effect of different dosage combinations of nalbuphine and sufentanil on postoperative analgesia in patients undergoing abdominal hysterectomy surgeries

目的探讨纳布啡复合舒芬太尼不同剂量组合用于腹式子宫切除术后镇痛的效果。方法选择2015年1月至2018年1月在徐州医科大学附属淮安医院择期行腹式子宫切除术患者125例,按随机数字表法分为舒芬太尼100μg组(S组)、舒芬太尼75μg+纳布啡25mg组(NS1组)、舒芬太尼50μg+纳布啡50mg组(NS2组)、舒芬太尼25μg+纳布啡75mg组(NS3组)和纳布啡100mg(N组),每组25例。五组术后镇痛负荷剂量3ml,持续剂量2ml/h,单次注射剂量0.5ml,锁定时间15min,总容量100ml。分别记录患者术后4、8、12、24和36h的切口痛和内脏痛的疼痛数字评分法(NRS)评分、Ramasy镇静评分、镇痛泵按压次数以及不良反应发生率。结果与NS3组和N组相比,术后4、8h切口痛NRS评分S组、NS1组及NS2组均明显降低(P<0.05);与S组和NS1组相比,术后4、8h的内脏痛NRS评分NS2组、NS3组及N组均明显降低(P<0.05);与NS2组相比,S组、NS1组、NS3组及N组的镇痛泵按压次数明显增多[(3.0±1.7)、(3.0±1.5)、(2.9±1.8)、(2.9±1.6)次比(1.7±1.0)次](P<0.05);与S组相比,术后恶心、呕吐发生率NS2组、NS3组及N组明显降低[恶心:8%(2/25)、8%(2/25)、4%(1/25)比20%(5/25),呕吐:8%(2/25)、8%(2/25)、8%(2/25)比20%(5/25)](P<0.05)。结论纳布啡复合舒芬太尼用于腹式子宫切除术后镇痛的最佳比例为1∶1,镇痛效果佳,不良反应发生率低。

Objective To observe the effect of different dosage combinations of nalbuphine and sufentanil on postoperative analgesia in patients undergoing abdominal hysterectomy surgeries. Methods One hundred and twenty-five patients scheduled for selective abdominal hysterectomy surgeries in Affiliated Huaian Hospital of Xuzhou Medical University from January 2015 to January 2018 were randomly divided into sufentanil 100 μg group (group S), sufentanil 75 μg combined with nalbuphine 25 mg group (group NS1), sufentanil 50 μg combined with nalbuphine 50 mg group (group NS2), sufentanil 25 μg combined with nalbuphine 75 mg group (group NS2) and nalbuphine 100 mg group (group N). The analgesic pump was set in the five groups as follows: loading dose 3 ml, continuous dose 2 ml/h, bolus dose 0.5 ml, lockout time 15 min, total volume 100 ml. The scores of incision pain and visceral pain of 4, 8, 12, 24 and 36 h of NRS, Ramasy sedation score, number of analgesia pump compressions and incidence of adverse reactions were recorded respectively in patients after operation. Results Compared with those in group NS3 and group N, the scores of incision pain of NRS were significantly lower 4 and 8 h after surgery in group S, group NS1 and group NS2 (P < 0.05). Compared with those in group S and group NS1, the scores of visceral pain of NRS was significantly lower at the time 4 and 8 h after surgery in group NS2, group NS3 and group N (P < 0.05). Compared with group NS2, the number of analgesia pump compression was significantly higher in group S, group NS1, group NS3 and group N,(3.0 ± 1.7),(3.0 ± 1.5),(2.9 ± 1.8),(2.9 ± 1.6) times vs.(1.7 ± 1.0) times, P < 0.05. Compared with those in group S, the nausea and vomiting were lower in group NS2, group NS3 and group N, nausea: 8%(2/25), 8%(2/25), 4%(1/25) vs. 20%(5/25), vomiting: 8%(2/25), 8%(2/25), 8%(2/25) vs. 20%(5/25), P < 0.05. Conclusions The optimal ratio of nalbuphine to sufentanil in postoperative analgesia after abdominal hysterectomy surgeries was 1∶1, because it has good analgesic effect and low incidence of adverse reactions.