纳布啡联合丙泊酚对无痛结肠镜肠息肉切除术患者麻醉效果的影响

Effects of nalbuphine combined with propofol on anaesthesia in patients with painless endoscopic polypectomy

目的探讨纳布啡联合丙泊酚对无痛结肠镜肠息肉切除术患者麻醉效果的影响。方法选取2018年1月至2020年12月在甘肃省人民医院行结肠镜肠息肉切除术患者56例作为研究对象,按随机数字表法分为观察组和对照组,各28例。对照组给予芬太尼联合丙泊酚麻醉诱导,观察组给予纳布啡联合丙泊酚麻醉诱导。比较两组患者平均动脉压、肾上腺素和心率水平,麻醉诱导时间、苏醒时间和丙泊酚用量,术后镇痛效果,治疗有效率,术后恶心呕吐、呼吸抑制、体动并发症发生率。结果麻醉前,观察组平均动脉压、肾上腺素和心率水平与对照组比较,差异无统计学意义(P>0.05);意识消失时和肠镜进入肛门时,观察组平均动脉压、肾上腺素和心率水平低于对照组[意识消失时:(11.85±1.62)k Pa比(13.87±1.98)kPa、(193.56±13.47)ng/L比(259.16±21.35)ng/L、(75.23±13.88)次/min比(82.23±12.58)次/min;肠镜进入肛门时:(12.98±2.69)kPa比(15.32±2.23)kPa、(198.25±25.81)ng/L比(261.22±23.28)ng/L、(78.2±15.37)次/min比(98.25±15.23)次/min],差异有统计学意义(P<0.05)。观察组麻醉诱导时间、苏醒时间和丙泊酚用量与对照组比较,差异无统计学意义(P>0.05)。观察组治疗有效率高于对照组[96.4%(27/28)比75.0%(21/28)],差异有统计学意义(P<0.05)。苏醒后30 min,观察组视觉模拟评分法(VAS)明显低于观察组[(1.39±0.56)分比(4.12±2.56)分],差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组[7.1%(3/28)比39.3%(11/28)],差异有统计学意义(P<0.05)。结论纳布啡联合丙泊酚用于结肠镜肠息肉切除术患者的麻醉效果和安全性高于芬太尼联合丙泊酚,可提高镇痛效果,有效降低恶心呕吐、呼吸抑制、体动并发症发生率。

Objective To explore effects of nalbuphine combined with propofol on anaesthesia in patients with painless endoscopic polypectomy. Methods Totally 56 patients with painless endoscopic polypectomy from January 2018 to December 2020 in our hospital were enrolled and randomly divided into observation group and control group, with 28 cases in each group. Control group was given fentanyl combined with propofol treatment;Observation group was given nalbuphine combined with propofol anesthesia induction treatment. The different time mean arterial pressure, heart rate and adrenaline level, the induction time, recovery time and the dosage of propofol, postoperative analgesic effect, the total efficiency of treatment, postoperative nausea and vomiting, respiratory depression, somatic complication rate were recorded and compared between two groups. Results Before anesthesia, the levels of mean arterial pressure, heart rate and epinephrine in observation group was not significantly different from those in control group(P>0.05);During loss of consciousness time and colonoscopy into anus time, the levels of mean arterial pressure, heart rate and epinephrine in observation group were significantly lower than those in control group [loss of consciousness Time:(11.85±1.62) kPa vs(13.87±1.98) kPa,(193.56±13.47) ng/L vs(259.16±21.35) ng/L,(75.23±13.88) times/min vs(82.23±12.58) times/min;colonoscopy into anus time:(12.98±2.69) kPa vs(15.32±2.23) kPa,(198.25±25.81) ng/L vs(261.22±23.28) ng/L,(78.2±15.37) times/min vs(98.25±15.23) times/min](P<0.05). The induction time, recovery time and the dosage of propofol in observation group were not significantly different from those in control group(P>0.05). The total effective rate in observation group was higher than that in control group[96.4%(27/28) vs 75.0%(21/28)](P<0.05) After waking up to 30 min, the visual analogue score in observation group was significantly lower than that in observation group [(1.39±0.56) scores vs(4.12±2.56) scores](P<0.05). The incidence of nausea and vomiting, respiratory depression, and postoperative complications in observation group were significantly lower than those in control group [7.1%(3/28) vs 39.3%(11/28)](P<0.05). Conclusions Anesthetic effect and safety on Nalbuphine therapy combined with propofol for colonoscopy bowel polyp resection were significantly higher than fentanyl combined with propofol. Nalbuphine therapy combined with propofol can enhance the analgesic effect, reduce nausea and vomiting, respiratory depression, somatic complications.