盐酸纳布啡联合舒芬太尼对髋关节置换术患者术后静脉自控镇痛效果的影响

Effect of nalbuphine hydrochloride combined with sufentanil on patient-controlled in travenous analgesia after hip replacement

目的:探讨盐酸纳布啡联合舒芬太尼对髋关节置换术(HR)患者术后静脉自控镇痛(PCIA)效果的影响。方法:选取2017年3月至2019年3月鄂东医疗集团黄石市中心医院收治的HR患者100例,按随机数字表法分为A组和B组,每组50例。A组术后PCIA给予舒芬太尼,B组在此基础上联合盐酸纳布啡,比较两组镇痛效果[视觉模拟评分法(VAS)、Ramsay镇静评分(RSS)]、炎症状态[C反应蛋白(CRP)、白介素-6(IL-6)、肿瘤坏死因子α(TNF-α)表达水平]、PCIA使用情况、镇痛满意度、不良反应。结果:B组术后2 h、12 h、24 h的VAS评分明显低于A组,B组术后2 h、12 h、24 h的RSS评分明显高于A组(P<0.05);B组术后CRP、IL-6、TNF-α表达水平明显低于A组(P<0.05);B组PCIA总按压次数、有效按压次数、用药量明显少于A组(P<0.05);B组镇痛满意率明显高于A组(P<0.05);B组不良反应发生率明显低于A组(P<0.05)。结论:盐酸纳布啡联合舒芬太尼可有效提高HR患者术后PCIA镇痛效果,有利于减少患者炎症反应及PCIA使用,且安全性更好,值得临床推广。

Objective:To discuss the effect of nalbuphine hydrochloride combined with sufentanil on patientcontrolled intravenous analgesia(PCIA)after hip replacement(HR).Methods:One hundred patients with HR from March 2017 to March 2019 were recruited in this study and divided into group A and group B randomly,with 50 patients in each group.Group A was given PCIA with sufentanil after HR,and group B was given nabuphine hydrochloride on group A’s basis,the analgesic effect(visual analogue scale,VAS;Ramsay sedation score,RSS),inflammatory state(C-reactive protein,CRP;interleukin-6,IL-6;tumor necrosis factor-alpha,TNF-alpha),the use of PCIA,analgesic satisfaction and adverse reactions were compared between these two groups.Results:The VAS scores in group B at 2,12 and 24 h were significantly lower than those in group A,and the RSS scores were significantly higher than those in group A(P<0.05).The CRP,IL-6,TNF-alpha in group B were significantly lower than those in group A(P<0.05).The total pressing times,effective pressing times and dosage of PCIA in group B were significantly lower than those in group A(P<0.05).The satisfaction rate of analgesia in group B was significantly higher than that in group A(P<0.05).The incidence of adverse reactions in group B was significantly lower than that in group A(P<0.05).Conclusions:Nalbuphine hydrochloride combined with sufentanil can effectively improve the analgesic effect of PCIA after HR,that is beneficial to reduce patients’inflammatory response the use of PCIA,and it has higher safety,which is worthy for further clinical promotion.