纳美芬联合舒芬太尼对腹腔镜结直肠癌根治术患者复苏质量的影响

Effects of nalmefene combined with sufentanil on the quality of resuscitation for patients undergoing radical resection of colorectal cancer

目的:观察纳美芬联合舒芬太尼对腹腔镜结直肠癌根治术患者复苏质量的影响。方法:选择2020年12月至2021年8月在广西医科大学第一附属医院接受腹腔镜结直肠癌根治术的100例患者(年龄≥18岁,且<80岁),按随机数字表法分为对照组(C组)和纳美芬组(N组),每组50例。C组患者麻醉诱导前给0.9%氯化钠,PCIA加同等剂量0.9%氯化钠;N组患者诱导前5 min,静推0.1μg/kg纳美芬,PCIA:舒芬太尼2μg/kg+纳美芬0.25μg/kg。两组患者术中麻醉方案相同。观察两组患者入PACU后Aldrete评分≥9分的时间、拔管时间、患者Ramsay躁动评分、镇痛VAS评分、PACU中是否使用补救镇痛药物(芬太尼)及其使用剂量和PACU中恶心呕吐、瘙痒发生率。结果:与C组相比,N组患者入PACU后Aldrete评分≥9分的时间及拔管时间均较短(P<0.05),N组患者术后Ramsay躁动评分较理想,患者安静程度较好(P<0.05);N组患者术后疼痛VAS评分较低,术后使用补充镇痛药物较少(P<0.05),镇痛效果较好。两组患者入PACU后恶心呕吐及瘙痒发生率均为零,差异无统计学意义(P>0.05)。结论:腹腔镜结直肠手术麻醉诱导前5 min给予小剂量纳美芬,术中及术后复合舒芬太尼,可加快患者麻醉后苏醒,增强术后镇痛效果,提高患者麻醉后复苏质量。

Objective:To observe the effect of nalmefene combined with sufentanil on the quality of resuscitation for patients undergoing laparoscopic radical resection of colorectal cancer.Methods:One hundred patients(age≥18 years and<80 years)who underwent laparoscopic radical resection of colorectal cancer at the First Affiliated Hospital of Guangxi Medical University from December 2020 to August 2021 were selected and divided into control group(group C)and nalmefene group(group N)using a random number table,with 50 patients in each group.Patients in group C were given 0.9%sodium chloride before induction of anesthesia,with equal dose of sodium chloride added to the patient-controlled intravenous analgesia pump(PCIA),while patients in group N were given 0.1μg/kg nalmefene intravenously and 2μg/kg of sufentanil+0.25μg/kg of nalmefene via PCIA.The intraoperative anesthesia protocol was the same in both groups.The time to Aldrete score≥9 after admission to the post anesthesia care unit(PACU),extubation time,Ramsay Sedation Scale score,pain VAS score,whether remedial analgesic drug(fentanyl)was used in PACU and its dose and the incidence of nausea,vomiting and pruritus in PACU were observed in both groups.Results:Compared with group C,patients in group N had a shorter time to Aldrete score≥9 and time to extubation after admission to the PACU(P<0.05);group N had a better postoperative Ramsay Sedation Scale score and were quieter(P<0.05);group N had a lower postoperative pain VAS score,less use of remedial analgesic drugs in the PACU(P<0.05),and better analgesic effect.The incidence of nausea,vomiting and pruritus after admission to PACU was zero in both groups,and the difference was not statistically significant(P>0.05).Conclusion:Giving a small dose of nalmefene 5 min before induction of anesthesia for laparoscopic colorectal surgery and adding sufentanil intraoperatively and postoperatively can accelerate patients’post-anesthesia awakening,enhance the postoperative analgesic effect and improve the quality of post-anesthesia resuscitation.