盐酸纳布啡在男性膀胱镜检查中的镇痛效果观察

Efficacy of nalbuphine in perioperative analgesia in the patients undergoing male cystoscopy

目的探讨不同剂量盐酸纳布啡注射液复合利多卡因乳膏表面麻醉用于男性膀胱镜检查围手术期镇痛的效果。方法选择海军军医大学第三附属医院2020年6月至2021年4月择期行膀胱镜检查的男性患者90例,按照随机数字表法将患者分为3组各30例,N_(1)组患者在膀胱镜检利多卡因乳膏表面麻醉前3 min静脉注射0.15 mg/kg盐酸纳布啡,N_(2)组患者在膀胱镜检利多卡因乳膏表面麻醉前3 min静脉注射0.1 mg/kg盐酸纳布啡,C组患者在膀胱镜检利多卡因乳膏表面麻醉前3 min静脉注射生理盐水。比较3组患者术中尿道疼痛评分(VAS)和镇静评分,记录各组患者术后恶心呕吐评分、头晕、呼吸抑制等不良反应例数,比较3组患者插镜成功率、操作时间及手术相关并发症。结果3组患者一般资料、术中操作时间、Ramsay镇静评分及总体满意度比较差异无统计学意义(P>0.05)。与C组相比,N_(1)组和N_(2)组患者插镜成功率增加,术中VAS疼痛评分及手术相关并发症发生率显著降低(P<0.05)。与N_(1)组相比,N_(2)组术后恶心呕吐等不良反应发生率显著降低(P<0.05)。结论0.1 mg/kg纳布啡复合利多卡因乳膏表面麻醉能明显减轻膀胱镜检疼痛,优于传统单纯利多卡因乳膏表面麻醉方案,具有较高的安全性,值得临床推广应用。

Objective To explore the effects of different doses of nalbuphine hydrochloride combined with lidocaine cream surface anesthesia for perioperative analgesia in the patients undergoing male cystoscopy.Methods 90 male patients who were expected to receive cystoscopy in the hospital from June 2020 to April 2022 were enrolled as research subjects.According to the random number table method,the patients were divided into 3 groups,each consisting of 30.Three minutes before topical anesthesia with lidocaine cream,the patients in the N_(1) group undergoing cystoscopy were injected with 0.15 mg/kg nalbuphine hydrochloride intravenously,the patients in the N_(2) group were given 0.1 mg/kg nalbuphine hydrochloride intravenously,3 minutes before topical anesthesia with lidocaine cream,while the patients in group C just received normal physiological saline at the same time point.The urethral pain scores(VAS)and sedation scores(Ramsay)were compared between the 3 groups.The scores of postoperative nausea and vomiting,and the cases of such adverse reactions as dizziness,and respiratory depression in each group were recorded for comparison.The success rate,operation time and operation-related complications were compared between the patients of the 3 groups.Results There was no statistical significance in general medical data,intraoperative manipulation time,Ramsay sedation scores and overall satisfaction rate when comparisons were made between the 3 groups(P>0.05).Compared with that of the C group,the success rate of intubation in the N_(1) and N_(2) groups increased,and the intraoperative VAS pain scores and the incidence of surgery-related complications in the latter 2 groups significantly decreased(P<0.05).Compared with those of the N_(1) group,the incidence of postoperative nausea and vomiting and other adverse reactions in the N_(2) group significantly lowered(P<0.05).Conclusion 0.1 mg/kg nalbuphine combined lidocaine cream surface anesthesia could significantly lessen pain of cystoscopy,which was obviously superior to the traditional simple lidocaine cream surface anesthesia profile alone,with better safety.For this reason,it is worth further clinical application.