盐酸纳布啡注射液对老年全膝关节置换术患者术中镇痛及应激因子水平的影响

Effects of nalbuphine hydrochloride injection on perioperative analgesia and stress factors levels in elderly patients undergoing total knee arthroplasty

目的探讨盐酸纳布啡注射液超前镇痛对老年患者行全膝关节置换术术中镇痛及应激因子水平的影响。方法选择择期行膝关节置换术,ASA分级为Ⅰ或Ⅱ级,年龄65~86岁的患者120例。分为纳布啡注射液组(Nal组)和0.9%氯化钠溶液组(NS组),麻醉方式选择超声引导下股神经联合坐骨神经阻滞。手术开始前30 min,分别给予Nal组患者盐酸纳布啡注射液0.3 mg/kg静注,NS组患者则给予等容量的0.9%氯化钠注射液。记录所有患者手术开始前30 min(T0),手术开始时(T1),手术开始后15(T2)、30(T3)、45 min(T4)及手术结束时(T5)MAP、HR水平;分别在T1~T5时对所有患者进行VAS评分,并记录2组患者VAS评分≥3分发生总次数,当VAS≥3分时给予患者0.5%的利多卡因5 ml局部麻醉,记录术中局麻药用量;分别在T1~T5取外周静脉血3 ml用于检测血浆应激因子Cor、TNF-α、IL-6浓度水平;记录所有患者术中高血压、低血压、心动过速、心动过缓、呼吸抑制等不良反应发生率。结果与NS组比较,Nal组患者MAP在T1~T5时更低,而HR则在T1~T4时更低,VAS评分在T1~T3时更低,Nal组患者术中利多卡因需要量要明显更少,VAS≥3分患者例数也更少(P<0.05)。Nal组血浆Cor、IL-6水平在T1~T5时低于NS组,而TNF-α水平则在T1~T4时更低(P<0.05)。此外,Nal组术中高血压及心动过速的发生率要明显低于NS组(P<0.05)。结论盐酸纳布啡注射液用于老年患者全膝关节置换术超前镇痛,有利于维持术中血流动力学稳定,降低术中疼痛评分,减少术中局麻药药需求,降低血浆应激因子Cor、TNF-α、IL-6浓度水平,减少术中不良事件发生率。

Objective To investigate the effects of nalbuphine hydrochloride injection on perioperative analgesia and stress factors levels in elderly patients undergoing total knee arthroplasty(TKA).Methods One hundred and twenty patients with American Society of Anesthesiologists(ASA)classⅠorⅡ,with 65~86 year of age,who were scheduled to undergo TKA,were randomly divided into nalbuphine injection(group Nal,n=60)and normal saline group(group NS,n=60).Ultrasound-guided femoral nerve block combined with sciatic nerve block were used for anesthesia.The patients in group Nal received nalbuphine hydrochloride injection 0.3mg/kg,30min before surgery,however,the patients in group NS received equal volume of normal saline.The MAP and HR were recorded at 30min before surgery(T0),the beginning of operation(T1),and at 15min(T2),30min(T3),and 45min(T4)after operation,and at the end of operation(T5),respectively.And VAS scores at T1~T5 were recorded,respectively.The VAS scores≥3 points were documented,and then 0.5%lidocaine of 5ml was given to provide local anesthesia,and the consumption of lidocaine was also observed.The peripheral venous blood of 3ml was extracted at T0~T5 respectively to detect the plasma levels of stress factors-Cor,TNF-αand IL-6.Moreover the incidence of intraoperative adverse reactions including hypertension,hypotension,tachycardia,bradycardia and respiratory depression were observed and compared between the two groups.Results As compared with those in group NS,the MAP levels in group Nal were lower at T1~T5,moreover,the HR levels at T1~T4 were much lower,and VAS scores were much lower in T1~T3.The consumption of lidocaine and the the patients with VAS≥3 points in group Nal were significantly lower than those in group NS(P<0.05).The plasma levels of Cor and IL-6 at T1~T5 in group Nal were significantly lower than those in group NS,moreover,the TNF-αlevels were much lower at T1~T4(P<0.05).In addition,the incidence rate of intraoperative hypertension and tachycardia in group Nal was significantly lower than that in group NS(P<0.05).Conclusion The application of preemptive analgesia with nalbuphine hydrochloride injection in patients undergoing TKA is beneficial tomaintain intraoperative hemodynamic stability,reduce the intraoperative VAS scores and consumption of intraoperativeanesthetics,decrease the plasma levels of stressfactor-Cor,TNF-α,IL-6,and reduce the incidencerates of adverse events during the operation.