纳布啡在肝脏肿瘤射频消融术中的安全性和有效性观察

Safety and feasibility of nalbuphine in radio frequency ablation of liver tumors

目的探讨纳布啡在肝脏肿瘤射频消融术中安全性和有效性。方法选取2018年1月至2020年7月在郑州大学第一附属医院行肝脏肿瘤射频消融术患者120例,随机均分为芬太尼组和纳布啡组,每组60例。2组术前分别静脉滴注芬太尼1μg/kg和纳布啡0.1 mg/kg,待术者完成穿刺后给予丙泊酚1.5 mg/kg维持麻醉。根据患者体动,追加适量丙泊酚。记录2组入室(T0)、射频消融开始(T1)、射频消融开始10 min(T2)、射频消融结束(T3)、患者清醒(T4)的心率(HR)、平均动脉压(MAP)、脉搏血氧饱和度(SpO2)。记录2组术中丙泊酚用量,苏醒时间,手术时间,术后0.5 h、1 h、2 h、4 h视觉模拟评分(VAS),以及呼吸抑制、恶心呕吐、眩晕、皮肤瘙痒等不良反应发生率。结果T0~T4各时间点,2组间及组内HR、MAP、SpO2比较差异均无统计学意义(P均>0.05)。纳布啡组术后0.5 h、1 h、2 h、4 h VAS评分,丙泊酚用量,呼吸抑制,恶心呕吐,皮肤瘙痒不良反应均低于芬太尼组,差异均有统计学意义(P均<0.05)。结论与芬太尼相比,纳布啡可满足肝脏肿瘤射频消融术镇痛要求,且麻醉相关不良反应少,在术后镇痛方面更具有优势。

Objective To evaluate the safety and feasibility of nalbuphine in the radio frequency ablation of liver tumors.Methods From January 2018 to July 2020 in the First Affiliated Hospital of Zhengzhou University,120 patients were randomly divided into the fentanyl group and the nalbuphine group,60 patients in each group.The two groups were given fentanyl 1μg/kg and nalbuphine 0.1 mg/kg before operation,and propofol 1.5 mg/kg was given to maintain anesthesia after puncture.Propofol was added according to the patient’s body movement.Heart(HR),mean arterial pressure(MAP)and pulse oxygen saturation(SpO2)were recorded at room entry(T0),beginning of radio frequency ablation(T1),10 minutes beginning of radio frequency ablation(T2),end of radio frequency ablation(T3)and patient’s consciousness(T4).The total consumption of propofol,recovery time,operation time and visual analogue scores(VAS)at 0.5 h,1 h,2 h and 4 h after operation were recorded,and the incidence of complications such as respiratory depression,nausea and vomiting,dizziness and pruritus in the two groups were recorded.Results There was no statistically significant difference in HR,MAP and SpO2 between the two groups(P>0.05).The VAS scores of 0.5 h,1 h,2 h,4 h,the dosage of propofol,respiratory depression,nausea and vomiting,vertigo and pruritus in the nalbuphine group were lower than in the fentanyl group(P<0.05).Conclusion Compared with fentanyl,nalbuphine can satisfy the analgesia requirement of liver tumor radio frequency ablation,has less complications related to anesthesia,and it has more advantages in postoperative analgesia.