纳布啡预防性镇痛对下肢骨科手术术后疼痛和血流动力学的影响

Effects of preventive analgesia with nalbuphine on postoperative pain and hemodynamics in lower limb orthopedic surgery

目的:观察纳布啡预防性镇痛对下肢骨科手术术后患者疼痛和血流动力学的影响。方法:选取2021年1月至2022年5月在徐州医科大学附属淮安医院择期行下肢骨科手术的患者116例,按随机数字表法将患者分为对照组(NS组)、纳布啡低剂量组(0.1 mg/kg,N1组)、纳布啡中剂量组(0.2 mg/kg,N2组)、纳布啡高剂量组(0.3 mg/kg,N3组),每组29例。所有患者均在蛛网膜下腔阻滞麻醉下进行手术,麻醉前15 min,N1组、N2组、N3组分别静脉推注0.1 mg/kg、0.2 mg/kg、0.3 mg/kg纳布啡(均使用生理盐水配成10 m L溶液),NS组同时静脉推注等量生理盐水。比较4组术后1 h(T1)、4 h(T2)、8 h(T3)、24 h(T4)及48 h(T5)静息状态下疼痛数字评分(NRS)、补救镇痛情况、平均动脉压(MAP)、心率(HR)及术后不良反应发生情况。结果:4组患者T1、T2、T3、T4、T5时间点静息状态下NRS评分、MAP、HR比较,差异均有统计学意义(均P<0.05)。与NS组或N1组比较,N2和N3组NRS评分降低,N3组血流动力学更为平稳(P<0.05)。与NS组比较,N2组和N3组术后首次补救镇痛时间延长,补救镇痛总量减少(P<0.05)。与NS组比较,N1组、N2组和N3组不良反应总发生率降低(P<0.05)。结论:纳布啡预防性镇痛能够有效缓解下肢骨科手术患者术后疼痛,提供稳定的血流动力学环境,减少术后不良反应。

Objective: To observe the effects of preventive analgesia with nalbuphine on pain and hemodynamics in patients after lower limb orthopedic surgery. Methods: One hundred and sixteen patients who underwent lower limb orthopedic surgery at the Affiliated Huai’an Hospital of Xuzhou Medical University from January 2021 to May 2022 were selected and divided using a random number table into control group(NS group), nalbuphine lowdose group(0.1 mg/kg, N1 group), nalbuphine medium-dose group(0.2 mg/kg, N2 group), and nalbuphine highdose group(0.3 mg/kg, group N3), 29 cases in each group. All patients underwent subarachnoid block anesthesia.Fifteen minutes before anesthesia, patients in N1 group, N2 group and N3 group were treated with intravenous infusion of 0.1 mg/kg, 0.2 mg/kg and 0.3 mg/kg nalbuphine, respectively. NS group was injected intravenously with normal saline. The numerical rating scale(NRS) scores at rest, remedial analgesia, mean arterial pressure(MAP), heart rate(HR) and the occurrence of postoperative adverse reactions at 1 h(T1), 4 h(T2), 8 h(T3), 24 h(T4) and 48 h(T5) postoperatively were compared between the four groups. Results: The differences in resting NRS scores, MAP, and HR at T1, T2, T3, T4, T5, and T6 were statistically significant when compared between the four groups of patients(all P<0.05). Compared with the NS or N1 groups, NRS scores were lower in the N2and N3 groups, and hemodynamics were more stable in the N3 group(P<0.05). Compared with the NS group,the time to first postoperative remedial analgesia was longer, and the total amount of remedial analgesia was reduced in the N2 and N3 groups(P<0.05). The overall incidence of adverse reactions was reduced in the N1,N2, and N3 groups compared with the NS group(P<0.05). Conclusion: Preventive analgesia with nalbuphine can effectively relieve postoperative pain, provide a stable hemodynamic environment and reduce postoperative adverse reactions in patients undergoing lower limb orthopedic surgery.