腹腔镜胃癌根治术后应用纳布啡与舒芬太尼多模式镇痛效果比较

Clinical effects of nalbuphine versus sufentanil on multimodal analgesia after laparoscopic radical gastrectomy

目的探讨纳布啡与舒芬太尼用于腹腔镜胃癌根治术后多模式镇痛的效果及安全性。方法行腹腔镜胃癌根治术患者100例,随机分为纳布啡组和舒芬太尼组各50例。纳布啡组采用纳布啡+酮咯酸氨丁三醇患者自控静脉镇痛(patient-controlled intravenous analgesia, PCIA)联合双侧腹横肌平面阻滞的多模式镇痛,舒芬太尼组采用舒芬太尼+酮咯酸氨丁三醇PCIA联合双侧腹横肌平面阻滞的多模式镇痛。比较2组术后2、6、12、24、48 h时切口疼痛视觉模拟评分(visual analogue scale, VAS)、内脏痛VAS评分和Ramsay镇静评分;比较2组术后补救镇痛例数、48 h内PCIA次数、48 h时镇痛满意度及术后不良反应发生情况。结果 2组年龄、性别比例、体质量指数、手术时间比较差异均无统计学意义(P>0.05)。2组患者术后均无需补救镇痛。纳布啡组术后6、12 h内脏痛VAS评分[(4.22±0.54)、(4.34±0.47)分]均低于舒芬太尼组[(4.50±0.58)、(4.62±0.49)分](P<0.05),术后2、24、48 h时内脏痛VAS评分与舒芬太尼组比较差异均无统计学意义(P>0.05);2组术后2、6、12、24、48 h时切口疼痛VAS评分及Ramsay镇静评分比较差异均无统计学意义(P>0.05)。纳布啡组术后48 h内PCIA次数[(2.7±0.9)次]少于舒芬太尼组[(5.1±1.1)次](P<0.05),术后48 h时镇痛满意度(86.00%)高于舒芬太尼组(60.00%)(P<0.05)。纳布啡组术后恶心呕吐发生率(4.00%)、嗜睡发生率(2.00%)均低于舒芬太尼组(18.00%、16.00%)(P<0.05),2组术后均未发生呼吸抑制、寒颤、头晕、尿潴留等不良反应。结论纳布啡用于腹腔镜胃癌根治术后多模式镇痛对内脏痛的镇痛效果优于舒芬太尼,恶心呕吐、嗜睡发生率低。

Objective To investigate the clinical effects of nalbuphine and sufentanil on multimodal analgesia after laparoscopic radical gastrectomy and their safeties. Methods Totally 100 patients undergoing laparoscopic radical gastrectomy for gastric cancer were randomly and equally divided into nalbuphine group and sufentanil group. Besides bilateral transverse abdominal muscle plane block, nalbuphine group received nalbuphine and ketorolac tromethamine for patient-controlled intravenous analgesia(PCIA), and sufentanil group received sufentanil and ketorolac tromethamine for PCIA after laparoscopic radical gastrectomy. At the time points of 2, 6, 12, 24 and 48 h after PCIA, incision visual analogue scale(VAS) score, visceral VAS score and Ramsay score were compared between two groups. The number of patients received analgesia, the frequency of PCIA in 48 h, patients’ satisfactory degree with analgesia in 48 h, and occurrence of postoperative complications were compared between two groups. Results There were no significant differences in age, sex ratio, body mass index and operation lasting time between two groups(P>0.05). No patients received remedial analgesia in two groups. Visceral VAS scores were lower in nalbuphine group(4.22±0.54, 4.34±0.47) than those in sufentanil group(4.50±0.58, 4.62±0.49) 6 and 12 h after PCIA(P<0.05), and showed no significant differences between two groups 2,24 and 48 hafter operation(P>0.05).The incision VAS scores and Ramsay scores showed no significant differences between two groups 2,6,12,24 and 48 hafter operation(P>0.05).The frequency of PCIA 48 hafter operation was less in nalbuphine group(2.7±0.9)than that in sufentanil group(5.1±1.1)(P<0.05).The patients\satisfactory degree with analgesia 48 hafter operation was higher in nalbuphine group(86.00%)than that in sufentanil group(60.00%)(P<0.05).The incidences of nausea/vomiting and somnolence were lower in nalbuphine group(4.00%,2.00%)than those in sufentanil group(18.00%,16.00%)(P<0.05).Respiratory depression,shiver,drizzle or uroschesis occurred in neither two groups.Conclusion Nalbuphine is superior to sufentanil in analgesia effect on visceral pain in multimodal analgesia after laparoscopic radical gastrectomy,with low incidences of nausea/vomiting and somnolence.