不同浓度盐酸纳布啡混合舒芬太尼术后自控静脉镇痛对妇科肿瘤开腹术病人炎症反应的影响

Effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia on inflammatory response in patients undergoing gynecological tumor laparotomy

目的评价不同浓度盐酸纳布啡混合舒芬太尼术后自控静脉镇痛对妇科肿瘤开腹术病人炎症反应的影响。方法择期拟行妇科肿瘤开腹术病人125例,年龄22~64岁,体重50~75 kg,ASA分级Ⅰ或Ⅱ级,采用随机数字表法分为5组(n=25):舒芬太尼1μg/ml组(S组)、舒芬太尼0.75μg/ml+盐酸纳布啡0.25 mg/ml组(N1组)、舒芬太尼0.5μg/ml+盐酸纳布啡0.5 mg/ml组(N2组)、舒芬太尼0.25μg/ml+盐酸纳布啡0.75 mg/ml组(N3组)和盐酸纳布啡1 mg/ml组(N4组)。术后行PCA(加入格拉司琼9 mg后用生理盐水稀释至150 ml,负荷量2 ml,背景剂量2 ml/h,自控剂量1 ml/次,锁定时间15 min)。静脉注射氟比洛芬酯50 mg进行补救镇痛,维持静态VAS评分≤4分和动态(咳嗽)VAS评分≤6分。于诱导前(T1)、切皮后1 h(T2)、术毕时(T3)、术后24和48 h(T4,5)时采集上肢静脉血,测定血清IL-6、TNF-α和IL-10浓度,记录术后24 h内PCIA有效按压次数、补救镇痛情况、恶心呕吐及嗜睡发生情况及术后肛门排气时间。结果与S组比较,N1组和N2组T4,5时血清IL-6和TNF-α浓度降低,IL-10浓度升高,其余组病人肛门排气时间缩短,恶心呕吐发生率降低,N2组PCIA有效按压次数减少,补救镇痛率降低,N4组嗜睡发生率升高(P<0.05)。结论舒芬太尼0.5μg/ml+盐酸纳布啡0.5 mg/ml术后自控静脉镇痛效果好,有效减轻炎症反应,降低不良反应发生。

Objective To evaluate the effects of different concentrations of nalbuphine hydrochloride mixed with sufentanil for postoperative patient-controlled intravenous analgesia(PCIA)on inflammatory response in the patients undergoing gynecological tumor laparotomy.Methods One hundred and twenty-five patients,aged 22-64 yr,weighing 50-75 kg,of American Society of Anesthesiologists physical statusⅠorⅡ,undergoing elective laparotomy for gynecologic tumors,were divided into 5 groups(n=25 each)by a random number table method:sufentanil 1μg/ml group(group S),sufentanil 0.75μg/ml+nalbuphine 0.25 mg/ml group(group N1),sufentanil 0.5μg/ml+nalbuphine 0.5 mg/ml group(group N2),sufentanil 0.25μg/ml+nalbuphine 0.75 mg/ml group(group N3),and nalbuphine 1 mg/ml group(group N4).Postoperative PCA(granisetron 9 mg was added,the PCA solution was diluted to 150 ml in normal saline,a loading dose of 2 ml,background dose of 2 ml/h,a self-controlled dose of 1 ml/time,and a lockout interval of 15 min)was performed.Flurbiprofen 50 mg was intravenously injected for rescue analgesia,maintaining a static visual analog scale score≤4 and a dynamic(cough)visual analog scale score≤6.Venous blood samples were collected from the upper extremity before induction(T1),at 1 h after incision(T2),at the end of operation(T3),and at 24 and 48 h after operation(T4,5)for determination of serum concentrations of interleukin-6(IL-6),tumor necrosis factor-alpha and IL-10.The effective pressing times of PCIA,requirement for rescue analgesia,development of nausea and vomiting and somnolence,and postoperative anal exhaust time were recorded within 24 h after surgery.Results Compared with group S,the concentrations of IL-6 and tumor necrosis factor-alpha in serum were significantly decreased,and the concentration of IL-10 was increased at T4,5 in N1 and N2 groups,the anal exhaust time was significantly shortened,and the incidence of nausea and vomiting was decreased in the other groups,the effective pressing times of PCIA and requirement for rescue analgesia were significantly decreased in group N2,and the incidence of somnolence was significantly increased in group N4(P<0.05).Conclusion Sufentanil 0.5μg/ml plus nalbuphine hydrochloride 0.5 mg/ml provides good PCIA,effectively reduces inflammatory responses and decreases the occurrence of adverse reactions in the patients undergoing gynecological tumor laparotomy.