纳布啡注射液在老年患者腹腔镜子宫切除术后PCIA中的应用

The application of nalbuphine injection in PCIA after laparoscopic hysterectomy in elderly patients

目的明确纳布啡注射液在老年患者腹腔镜子宫切除术后PCIA中的效果。方法选择2018年4月-2019年4月本院收治的拟行腹腔镜子宫切除术患者50例作为研究对象,年龄65~75岁,ASAⅡ或Ⅲ级。采用随机数表法分为纳布啡注射液PCIA组(N组)和舒芬太尼注射液PCIA组(S组),每组各25例。N组配方:纳布啡注射液2 mg/kg+维生素B 6100 mg,生理盐水稀释至100 ml,不设负荷量,背景输注速率2 ml/h,PCA剂量2 ml,锁定时间15 min;S组配方:舒芬太尼注射液2μg/kg+维生素B 6100 mg,生理盐水稀释至100 ml,不设负荷量,背景输注速率2 ml/h,PCA剂量2 ml,锁定时间15 min。采用视觉模拟评分法(VAS)评估术后2 h、4 h、8 h、12 h、24 h、48 h时两组静息和活动时的疼痛程度;记录48 h内自控镇痛(PCA)总按压次数和有效按压次数,同时观察术后各时点患者Ramsay镇静评分以及恶心呕吐、皮肤瘙痒、呼吸抑制等不良反应。结果与S组比较,N组患者术后8 h、12 h、24 h活动状态时VAS评分均降低(P<0.05);N组患者术后48 h内PCA总按压次数及有效按压次数明显低于S组(P<0.05);N组术后48 h内恶心呕吐发生率明显低于S组(P<0.05)。结论纳布啡注射液在老年患者腹腔镜子宫切除术后PCIA的镇痛效果优于与等效剂量的舒芬太尼注射液,术后恶心呕吐发生率也低于舒芬太尼注射液。

Objective To clarify the application efficacy of nalbuphine in PCIA after laparoscopic hysterectomy in elderly female patients.Methods 50 cases of patients those intended to carry out laparoscopic hysterectomy in our hospital between April 2018 and April 2019 were enrolled as study subjects,they were aged from 65 to 75 years old,all of which ASA grade II or III.They were divided into observation group(nalbuphine PCIA group,N group)and control group(sufentanil PCIA group,S group),25 cases in each group.The formula of group N:nalbuphine injection 2 mg/kg+vitamin B6100 mg,diluted to 100 ml with saline solution,without load,background infusion rate of 2 ml/h,PCA dose 2 ml,locking time for 15 minutes.The formula of group S:sufentanil injection 2 ug/kg+vitamin B6100 mg,diluted to 100 ml with saline solution,without load,background infusion rate of 2 ml/h,PCA dose 2 ml,locking time 15 minutes.To assess the degree level of pain of the two groups during rest and activity,the visual analogue scale(VAS)has been adopted to record the scores of the two groups at 2,4,8,12,24,48 hours after operation respectively.Efforts such as recording the total press times and the effective press times of patient controlled analgesia(PCA)within 48 hours after operation,comparing the Ramsay sedation scores,and observing the nausea and vomiting,pruritus,respiratory depression and other adverse reactions at various times after operation have been made before we coming to a conclusion.Results Compared with group S,the scores of VAS of patients in group N under conditions of activity decreased at 8,12,24 hours after operation(P<0.05).The total press times of PCA and effective press times in group N within 48 hours after operation were significantly lower than group S(P<0.05).The incidences of nausea and vomiting in group N within 48 hours after operation were significantly lower than that of group S(P<0.05).Conclusions The analgesic efficacy of nalbuphine injection in PCIA in elderly patients after laparoscopic hysterectomy is better than equivalent doses of sufentanil injection.The incidence of postoperative nausea and vomiting induced by nalbuphine was also lower than those induced by sufentanil injection.