腹腔镜肝切除术治疗原发性肝癌患者应用氢吗啡酮联合纳布啡静脉自控镇痛控制疼痛作用研究

hydromorphone and nalbuphine combination for patient-controlled intravenous analgesia in patients with primary liver cancer undergoing laparoscopic hepatectomy

目的探讨腹腔镜肝切除术(LH)治疗原发性肝癌(PLC)患者应用氢吗啡酮联合纳布啡静脉自控镇痛(PCIA)控制疼痛的效果。方法2018年1月~2021年1月我院收治的PLC患者104例,随机分为对照组52例和观察组52例,两组患者均接受LH手术,在对照组,给予舒芬太尼联合纳布啡用于术后PCIA,而在观察组给予氢吗啡酮联合纳布啡用于术后PICA。采用疼痛视觉模拟评分(VAS)评价术后疼痛程度,使用流式细胞仪检测外周血T细胞亚群CD3^(+)细胞、CD4^(+)细胞、CD8^(+)细胞和NK细胞百分比。结果在术后24 h,观察组静态VAS和动态VAS分别为(2.5±0.8)分和(3.7±1.2)分,显著低于对照组【分别为(4.3±1.2)分和(5.8±1.7),P<0.05】,在术后72 h,静态VAS和动态VAS分别为(1.1±0.4)分和(3.2±0.9)分,显著低于对照组【分别为(2.6±0.7)分和(5.1±1.3),P<0.05】;术后,两组肝功能指标变化无显著性差异(P>0.05);在术后7 d,观察组外周血CD3^(+)细胞、CD4^(+)细胞、CD8^(+)细胞和NK细胞百分比分别为(76.3±7.5)%、(36.8±4.9)%、(32.5±3.2)%和(16.3±2.9)%,与对照组【分别为(75.2±7.4)%、(37.6±4.4)%、(31.2±3.4)%和(17.4±2.6)%】比,差异无统计学意义(P>0.05)。结论氢吗啡酮联合纳布啡用于LH后PCIA能够有效减轻患者疼痛程度。

Objective The aim of this study was to investigate pain control by hydromorphone and nalbuphine combination for patient-controlled intravenous analgesia(PCIA)in patients with primary liver cancer(PLC)undergoing laparoscopic hepatectomy(LH).Methods 104 patients with PLC were encountered in our hospital between January 2018 and January 2021,and they were randomly divided into control(n=52)and observation group(n=52).All patients with PLC underwent LH,and the sufentanil and nalbuphine in patients in the control,while the hydromorphone and nalbuphine in patients in the observation for postoperative PCIA were applied.The T cell subsets,such as CD3^(+)cells,CD4^(+)cells,CD8^(+)cells and NK cells,were detected by flow cytometry.The postoperative pain was assessed by visual analogue scale(VAS).Results At 24 h after surgery,the static and dynamic VAS scores in observation group were(2.5±0.8)points and(3.7±1.2)points,significantly lower than[(4.3±1.2)points and(5.8±1.7)points,P<0.05]in the control;at 72 h after surgery,the static and dynamic VAS scores in the observation group were(1.1±0.4)points and(3.2±0.9)points,significantly lower than[(2.6±0.7)points and(5.1±1.3)points,P<0.05]in the control;after surgery,there were no significant differences as respect to common liver function tests(P>0.05);at 7 d after surgery,the percentages of CD3^(+)cells,CD4^(+)cells,CD8^(+)cells and NK cells in the observation group were(76.3±7.5)%,(36.8±4.9)%,(32.5±3.2)% and(16.3±2.9)%,all not significantly different as compared to[(75.2±7.4)%,(37.6±4.4)%,(31.2±3.4)% and(17.4±2.6)%]in the control(P>0.05).Conclusion The application of hydromorphone and nalbuphine combination in patients with PLC for PCIA after LH could effectively alleviate pain.