不同剂量纳布啡复合曲马多对妇科手术全麻苏醒期镇痛效果的影响

Effect of analgesic effect of different doses of nalbuphine combined with tramadol on general anesthesia recovery

目的观察不同剂量纳布啡复合曲马多用于腹腔镜下全子宫切除术患者全麻苏醒期镇痛的效果和安全性。方法择期行全身麻醉腹腔镜全子宫切除术患者400例,年龄45~65岁,体重50~90 kg,ASAⅠ或Ⅱ级,按完全随机法分为四组:手术结束前30 min,A组静注纳布啡0.1 mg/kg+曲马多2 mg/kg;B组静注纳布啡0.2 mg/kg+曲马多2 mg/kg;C组静注纳布啡0.3 mg/kg+曲马多2 mg/kg;D组静注曲马多2 mg/kg。记录四组手术时间、苏醒时间;记录拔管时间;记录拔管后5、15、30 min警觉/镇静评分和VAS评分;记录手术后24 h内不良反应的发生情况。结果四组手术时间、苏醒时间和拔管时间差异无统计学意义。四组拔管后5、15、30 min警觉/镇静评分差异无统计学意义。拔管后15、30 min D组VAS评分明显高于B、C组(P<0.05)。拔管后30 min A组VAS评分明显高于C组(P<0.05)。四组拔管后呼吸抑制、头晕嗜睡发生率差异无统计学意义。D组恶心呕吐发生率明显高于A、B和C组(P<0.05)。结论全麻手术结束前30 min采用纳布啡0.2~0.3 mg/kg复合曲马多2 mg/kg较纳布啡0.1 mg/kg复合曲马多2 mg/kg全麻苏醒期镇痛效果好,不增加不良反应。

Objective To observe the efficacy and safety of different doses of nalbuphine combined with tramadol for analgesia during general anesthesia recovery in patients undergoing laparoscopic hysterectomy.Methods A total of 400 patients aged 45-65 years,weighing 50-80 kg,ASA physical statusⅠorⅡ,undergoing laparoscopic uterine surgery were selected.They were divided into 4 groups according to a completely randomized method.Group A was given nalbuphine 0.1 mg/kg+tramadol 2 mg/kg 30 min before the end of surgery.In group B,nalbuphine 0.2 mg/kg+tramadol 2 mg/kg was intravenously administered 30 min before the end of surgery.In group C,nalbuphine 0.3 mg/kg+tramadol 2 mg/kg was intravenously administered 30 min before the end of surgery.In group D,tramadol 2 mg/kg was intravenously administered 30 min before the end of surgery.The duration of surgery,the time of waking,the time of extubation,the vigilance/sedation score at 5,15 and 30 min after extubation the VAS score at 5,15 and 30 min after extubation and the incidence of adverse reactions within 24 h were compared.Results There was no significant difference in the recovery time and extubation time between the four groups.There were no significant differences in the alert/sedation scores between the four groups 5,15 and 30 min after extubation.There was no significant difference in VAS scores between the four groups 5 min after extubation.The VAS scores of group D at 15 and 30 min after extubation were significantly higher than those of the groups B and C(P<0.05).The difference of VAS score 30 min after extubation between groups A and C was statistically significant(P<0.05).There was no significant difference in the incidence of respiratory depression,dizziness and drowsiness after extubation in the four groups.The incidence of nausea and vomiting in group D was significantly higher than that in the other three groups(P<0.05).Conclusion Nalbuphine 0.2-0.3 mg/kg+tramadol 2 mg/kg at 30 min before the end of general anesthesia surgery has better analgesic effect than nalbuphine 0.1 mg/kg+tramadol 2 mg/kg during the recovery period of general anesthesia without significant increase in adverse reactions.