右美托咪定复合纳布啡治疗腹部大手术病人术后早期急性疼痛疗效观察

Effect of dexmedetomidine combined with nalbuphine on the treatment of early postoperative acute pain in patients undergoing major abdominal surgery

目的观察右美托咪定复合纳布啡对腹部大手术病人术后早期急性疼痛治疗的效果。方法 2016年11月至2018年11月安徽医科大学第二附属医院收治的在普外科上腹部开放性手术术后进入麻醉科重症监护室(AICU)的病人60例,均疼痛评分>3分,随机数字表法分为2组,纳布啡组(N组)和右美托咪定复合纳布啡组(YN组),N组病人给予纳布啡20 mg静脉推注,YN组给予纳布啡20 mg静脉推注,同时右美托咪定1.0μg/kg在15 min泵注,接着0.3μg·kg-1·h-1速度泵注30 min。每15分钟测一次视觉模拟评分(VAS),如果仍然>3分,给予舒芬太尼3微克/次。比较两组病人VAS评分,镇静评分(Ramsay),舒适度(BCS)评分,对AICU治疗满意度,AICU驻留时间,术后早期舒芬太尼累计用量,基本生命体征变化以及常见不良反应发生情况。结果治疗后15 min和30 min两个时点YN组VAS评分分别为(2.61±0.91)分、(2.14±0.67)分,低于N组(3.33±1.15)分、(2.92±0.94)分;两组病人比较差异有统计学意义(P<0.05)。治疗后15 min,YN组病人舒适评分为(0.68±0.12)分,高于N组(0.36±0.49)分,两组病人比较差异有统计学意义(P<0.05)。治疗后1 h,2 h舒芬太尼累计用量分别为YN组分别为(3.5±1.5)、(6.7±1.7)μg,明显小于N组的(4.6±2.3)、(7.8±2.4)μg(P<0.05)。治疗后30 min,60 min,120 min 3个时点,镇静评分=1分、2~4分者,病人对AICU治疗满意度,两组比较均差异有统计学意义(P<0.05)。AICU驻留时间、基本生命体征变化及各种不良事件发生率两组差异无统计学意义。结论右美托咪定复合纳布啡对腹部大手术病人术后早期急性疼痛治疗效果确切,提高了病人对AICU治疗的满意度。

Objective To observe the effect of dexmedetomidine combined with nalbuphine on the treatment of early postoperative acute pain in patients undergoing major abdominal surgery.MethodsFrom November 2016 to November 2018,60 patients admitted to the Anesthesia Intensive Care Unit(AICU)after the open surgery of the general abdomen in the Second Affiliated Hospital of Anhui Medical University,whose pain of VAS>3,were randomly divided into 2 groups(n=30 each)by random number table method:Group nalbuphine(Group N)and Group nalbuphine combined with dexmedetomidine.(Group YN).20 mg nalbuphine was intravenously injected in Group N.In Group YN,except nalbuphine was administrated as Group N,1 ug/kg dexmedetomidine was intravenously infused in 15 minutes as a bolus,following by 0.3μg·kg-1·h-1 for 30 minutes.VAS was assessed every 15 minutes,if VAS still>3,3 ug sufentanil was intravenously injected.Compare VAS scores,sedation scores Ramsay and Bruggrmann comfort scale(BCS),and cumulative sufentanil consumption in early stage of postoperation,patient satisfaction of the treatment in AICU,time of AICU stay and cumulative postoperative sufentanil consumption,changes in basic vital signs and common occurrence of adverse reactions.ResultsVAS Score was significantly lower in Group YN than in Group N at 15 minutes and 30 minutes after nalbuphine administrated(15 minutes after treatment,Group YN(2.61±0.91)versus Group N(3.33±1.15),P<0.05;30 minutes after treatment,Group YN,(2.14±0.67)versus Group N,(2.92±0.94),P<0.05].BCS score was significantly higher in Group YN than in Group N at 15 minutes after nalbuphine administrated[Group YN,(0.68±0.12),Group N,(0.36±0.49),P<0.05].The cumulative sufentanil dosage was lower in Group YN than Group N at 1 hour and 2 hour after nalbuphine administrated(1 hour after treatment,YN(3.5±1.5)μg versus N,(4.6±2.3)μg,P<0.05;2 hour after treatment,YN,(6.7±1.7)μg versus N,(7.8±2.4)μg,P<0.05].Number of patients with ramsay score=1 was less in Group YN than that in Group N,while Number of patient with ramsay score=2-4 was more in Group YN than that in Group N(P<0.01).Patient satisfaction of the treatment in AICU was higher in Group YN than Group N(P<0.05).There were no statistically significant differences between the two groups in AICU residence time,changes in basic vital signs,and the incidence of various adverse events.ConclusionThe dexmedetomidine combined with nalorphine has a definite effect on early postoperative acute pain treatment in patients undergoing major abdominal surgery,which can increase patient’s satisfaction with AICU treatment.