纳布啡联合丙泊酚对行肠道内镜黏膜下剥离术患者血流动力学和应激反应的影响

Nalbuphine Combined with Propofol on Hemodynamics and Stress Response in Patients Underwent Intestinal ESD

目的 探讨纳布啡联合丙泊酚对行肠道内镜黏膜下剥离术(ESD)患者的血流动力学和应激反应的影响。方法 选取武警贵州总队医院2016年10月至2019年3月收治行肠道ESD的患者105例,按随机数字表法分为对照组(52例)和研究组(53例)。对照组患者麻醉药物选用舒芬太尼联合丙泊酚,研究组患者麻醉药物选用纳布啡联合丙泊酚。结果 与麻醉前5 min(T1)比较,两组患者麻醉开始(T2)、手术开始5 min(T3)、手术开始30 min(T4)时心率(HR)、平均动脉压(MAP)、血氧饱和度(SpO2)均显著下降后趋于平缓(P<0.05),研究组患者T2T4各时点SpO2显著高于对照组(P<0.05);与T1比较,两组患者T2T5各时点去甲肾上腺素(NE)、皮质醇(Cor)水平均显著升高(P<0.05),但研究组显著低于对照组(P<0.05);研究组患者丙泊酚用量显著少于对照组,术后视觉模拟评分显著低于对照组(P<0.05);研究组呼吸抑制、呛咳、恶心呕吐发生率显著低于对照组(P<0.05)。结论 肠道ESD术中麻醉选用纳布啡联合丙泊酚,可减轻对机体血流动力学和应激反应的影响,且能减少呼吸抑制、呛咳、恶心呕吐等不良反应的发生。

Objective To investigate the effect of nalbuphine combined with propofol on hemodynamics and stress response in patients underwent endoscopic submucosal dissection(ESD).Methods A total of 105 patients with intestinal ESD admitted to Guizhou Armed Police Corps Hospital from October 2016 to March 2019 were selected and divided into the control group(n=52)and study group(n=53)according to random number table method.In the control group,sufentanil combined with propofol was used as anesthetic.Nalbuphine combined with propofol was used as anesthetic in the study group.Results Compared with the time point of 5 min before anesthesia(T1),the heart rate(HR),mean arterial pressure(MAP),pulse oxygen saturation(SpO2)of the two groups decreased gradually from the beginning of anesthesia(T2),5 min after operation(T3),to 30 min during the operation(T4),and then tended to be flat(P<0.05);the level of SpO2 in the study group was higher than that in the control group at the time points of T2-T4(P<0.05).Compared with T1,the levels of norepinephrine(NE)and cortisol(Cor)in the two groups increased gradually from T2 to T5(P<0.05),and the levels of NE and Cor were lower in the study group at T2-T5 compared with the control group(P<0.05).The dosage of propofol in the study group was less than that in the control group,and the score of visual analogue scale(VAS)was less than that in the control group(P<0.05).The incidence of respiratory depression,cough and nausea and vomiting in the study group was significantly lower than that in the control group(P<0.05).Conclusion Nalbuphine combined with propofol can alleviate the effects on hemodynamics and stress response,and reduce the incidence of respiratory depression,cough and nausea and vomiting in patients with intestinal ESD.