纳布啡超前镇痛模式在腹腔镜肝部分切除手术中的临床应用效果探究

Clinical Application of Nalbuphine Pre-analgesia Mode in Laparoscopic Partial Hepatectomy

目的探究纳布啡超前镇痛在腹腔镜肝部分切除手术中的临床应用效果及安全性,为其在腹腔镜肝切除手术中的合理使用提供依据。方法选择武汉市中心医院肝胆胰外科2020年3月至2021年3月之间符合纳入标准的择期行腹腔镜下肝部分切除术的患者60例,以随机数字法分为实验组及对照组各30例。两组常规全身麻醉,在手术开始前,实验组予0.2 mg/kg的剂量静脉滴注纳布啡(湖北宜昌人福药业,2 mL∶20 mg),对照组滴注等量的生理盐水。记录比较两组患者术后2、4、8、12、24、48 h时的NRS(numeric rating scales)数字量表疼痛评分,Ramsay镇静评分,术后48 h追加的镇痛次数和药物剂量,术后恶心呕吐、头晕、腹胀、呼吸抑制等不良反应的发生情况。结果实验组术后2、4、8、12、24 h时的NRS疼痛评分明显低于对照组,差异具有统计学意义(P<0.05),术后24 h Ramsay镇静评分明显高于对照组,差异具有统计学意义(P<0.05),术后48 h两组患者疼痛评分及镇静评分差异无统计学意义(P>0.05)。术后48 h时追加镇痛次数及药物剂量实验组低于对照组,差异具有统计学意义(P<0.05)。两组患者术后不良反应发生率差异无统计学意义(P>0.05)。结论预防性应用纳布啡可明显缓解腹腔镜下肝部分切除患者术后的疼痛,临床应用具有有效性及安全性。

Objective To investigate the clinical effect and safety of nalbuphine pre analgesia in laparoscopic partial hepatectomy and provide the basis for its rational use in laparoscopic hepatectomy.Methods 60 cases accepted laparoscopic partial hepatectomy in Hepatobiliary and Pancreatic Surgery of The Central Hospital of Wuhan from March 2020 to March 2021,who conforming to the standard were randomly divided into a control and an experimental group with 30 cases.The experimental group was given 0.2 mg/kg nalbuphine(Yichang Humanwell Pharmaceutical Co.,Ltd.,2 mL∶20 mg)intravenous infusion before surgery,while the control group was given the same amount of normal saline infusion simultaneously.NRS pain scores and Ramsay sedation scores at 2,4,8,12,24,and 48 h after surgery were recorded and evaluated,and additional analgesia times and doses at 48 h after surgery were calculated.The incidence of nausea,vomiting,dizziness,abdominal distension,respiratory depression,and other adverse reactions was recorded.Results The NRS pain scores of the experimental group at 2,4,8,12,and 24 h after operation were significantly lower than those of the control group(P<0.05).The Ramsay sedation score at 24 h after operation was significantly higher in the experimental group compared with that of the control group(P<0.05).There was no significant difference in NRS pain score and Ramsay sedation score between the two groups 48 h after surgery(P>0.05).The number and dose of additional analgesia at 48 h after operation in the experimental were significantly less than those in the control group(P<0.05).There was no significant difference in the incidence of postoperative adverse reactions between the two groups(P>0.05).Conclusion The prophylactic application of nalbuphine can significantly relieve postoperative pain in patients undergoing laparoscopic partial hepatectomy,which is effective and safe in clinical application.