纳布啡联合酮咯酸氨丁三醇预防性镇痛对鼻内镜手术患者术后疼痛及恢复质量的影响

Clinical effect of Nalbuphine combined with Ketorolac on preventive analgesia on postoperative pain and quality of recovery in patients underwent endoscopic sinus surgery

目的观察纳布啡联合酮咯酸氨丁三醇预防性镇痛对鼻内镜手术患者术后疼痛及恢复质量的影响。方法选取2019年6月-2020年4月该院择期行鼻内镜下鼻中隔偏曲矫形术治疗的患者46例,随机分为纳布啡联合酮咯酸氨丁三醇组(NK组)和酮咯酸氨丁三醇对照组(C组),每组23例。两组患者均于麻醉诱导前10 min行预防性镇痛,NK组分别静脉注射纳布啡0.13 mg/kg和酮咯酸氨丁三醇30 mg,C组静脉注射酮咯酸氨丁三醇30 mg。术中采用丙泊酚和瑞芬太尼全凭静脉麻醉。记录术后24 h内视觉模拟评分(VAS)、Ricker镇静-躁动评分(SAS)、术后24 h补救镇痛药物消耗量及补救镇痛率、术前1 d (T_0)、术后1 d (T_1)和术后2 d (T_2) 19点至21点的40项恢复质量评分量表(QoR-40)以及术后24 h不良反应发生率。结果NK组术后2、4、8、12和24 h VAS评分、术后24 h补救镇痛药物消耗量和补救镇痛率及术后2、4、8和12 h SAS评分均低于C组,两组比较,差异均有统计学意义(P <0.05);NK组T_1时点QoR-40评分中身体舒适度、疼痛和总评分及T_2时点身体舒适度、自理能力、心理支持、疼痛和总评分较高,两组比较,差异均有统计学意义(P <0.05);两组术后24 h不良反应发生率比较,差异无统计学意义(P> 0.05)。结论鼻内镜手术患者使用纳布啡联合酮咯酸氨丁三醇可达到术后预防性镇痛的作用,并能促进术后早期恢复。

Objective To observe the clinical effect of prophylactic analgesia of Nalbuphine combined with Ketorolac on postoperative pain and quality of recovery in patients underwent endoscopic sinus surgery.Methods 46 patients with nasal endoscopic septal deviation orthodontic treatment from June 2019 to April 2020 were selected and randomly divided into two groups:Nalbuphine combined with Ketorolac group(NK group)and Ketorolac control group(C group),with 23 patients in each group.Patients in each group underwent prophylactic analgesia 10 minutes before induction of anesthesia.The NK group was given intravenous Nalbuphine 0.13 mg/kg and Ketorolac 30 mg,and the C group was given intravenous Ketorolac 30 mg.During the operation,Propofol and Remifentanil were used for intravenous anesthesia.Record the visual analogue scale(VAS)in 24 h postoperatively;record the consumption of remedial analgesic drugs and the analgesic rate at 24 h postoperatively;record the Ricker sedation-restlessness scale(SAS)in 24 h;Record the scores of 40-item quality of recovery questionnaire(QoR-40)at 19 to 21 o’clock at 1 day before the operation(T0),1 day after operation(T1)and 2 days after operation(T2),and the incidence of adverse reactions 24 hours after operation.Results The NK group had VAS scores at 2 h,4 h,8 h,12 h and 24 h after surgery,consumption of salvage analgesics at 24 h after surgery,salvage analgesia rate at 24 h after surgery,and 2 h,4 h,8 h,and 12 h after surgery SAS scores were lower than those in group C,and the differences were statistically significant(P<0.05);The physical comfort,pain,and total scores of QoR-40 scale at T1 and the physical comfort,self care ability,psychological support,pain,and total scores of QoR-40 scale at T2 in NK group increased,and the differences were statistically significant(P<0.05);The incidence of adverse reactions 24 hours after operation of the two groups were not statistically significant(P>0.05).Conclusion Nalbuphine combined with Ketorolac has achieved the purpose of preventive analgesia and promoted early recovery after nasal endoscopic surgery.