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纳布啡预处理对急性结石性胆囊炎腹腔镜下切除术中血流动力学、应激反应及术后疼痛的影响 被引量:13

Effects of nalbuphine pretreatment on intraoperative hemodynamics,stress response and postoperative pain of acute calculous cholecystitis with laparoscopic resection
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摘要 目的探究纳布啡预处理对急性结石性胆囊炎(ACC)行腹腔镜胆囊切除术(LC)患者术中血流动力学、应激反应及术后疼痛的影响。方法选取2015年9月至2019年12月海军安庆医院收治的80例ACC拟行LC患者,按治疗方法分成观察组、对照组,各40例,2组均行静脉-吸入复合麻醉,观察组在麻醉诱导前给予纳布啡20 mg静脉注射,对照组给予等量生理盐水,记录2组手术时间、术中出血量、术中丙泊酚及舒芬太尼用量,比较2组麻醉诱导前(T_(0))、气管插管即刻(T_(1))、气腹建立后5 min(T_(2))、胆囊切除时(T_(3))、手术结束时(T_(4))、拔管即刻(T_(5))的心率(HR)及平均动脉压(MAP),于T_(0)、T_(3)、T_(5)时刻采集患者静脉血检测去甲肾上腺素(NE)、皮质醇(COR)水平,采用疼痛视觉模拟量表(VAS)评价患者术后1、6、12、24 h疼痛情况,记录2组术后曲马多、哌替啶使用率。结果观察组术中丙泊酚、舒芬太尼用量均低于对照组(P<0.05);与T_(0)时比较,2组T_(1)、T_(3)、T_(5)时HR、MAP均明显上升(P<0.05),且观察组T_(1)、T_(2)、T_(3)、T_(4)时HR、MAP均明显低于同时间点对照组(P<0.05);2组T_(3)时血清NE、COR水平较T_(0)时明显上升(P<0.05),T_(5)时较T_(3)时均下降(P<0.05),且观察组T_(3)、T_(5)时血清NE、COR水平均明显低于同时间点对照组(P<0.05);2组术后1、6、12、24 h各时间点VAS评分均呈下降趋势,且观察组术后各时间点VAS评分均显著低于同时间点对照组(P<0.05);观察组术后曲马多、哌替啶使用率分别为32.50%、5.00%,均低于对照组的55.00%、22.50%,差异有统计学意义(P<0.05)。结论ACC行LC患者麻醉诱导前予以纳布啡预处理,有利于减少术中丙泊酚、瑞芬太尼用量,减小血流动力学波动及应激反应,减轻术后疼痛并降低止痛药使用率。 Objective To explore the effects of nalbuphine pretreatment on intraoperative hemodynamics,stress response and postoperative pain in the patients with acute calculous cholecystitis(ACC)undergoing laparoscopic cholecystectomy(LC).Methods Eighty patients with ACC who were scheduled to undergo LC between the period of September 2015 and December 2019 in the Navy Anqing Hospital were enrolled for study,and were divided into the observation and control groups,each consisting of 40 patients.Both groups underwent intravenous inhalation‐combined anesthesia,and the observation group was intravenously injected 20 mg of nalbuphine before anesthesia induction,while the control group was just given equal volume of normal saline.The surgical time,intraoperative blood loss,intraoperative propofol dosage and sufentanil dosage were recorded in the two groups.The heart rate(HR)and mean arterial pressure(MAP)at the time points of before anesthesia induction(T_(0)),immediately after tracheal intubation(T_(1)),at 5min after establishment of pneumoperitoneum(T_(2)),at cholecystectomy(T_(3)),at the end of surgery(T_(4))and immediately after extubation(T_(5))were compared between the two groups.The venous blood of the patients were collected at T_(0),T_(3)and T_(5)and the levels of norepinephrine(NE)and cortisol(COR)were detected.The pain visual analogue scale(VAS)was used to evaluate the seriousness of pain at 1,6,12 and 24 h after surgery.The consumtion rates of tramadol and pethidine after surgery were recorded in the two groups.Results The consumption rates of propofol dosage and sufentanil during surgery in the observation group were lower than those in control group(P<0.05).Compared with the time point at T_(0),the HR and MAP at T_(1),T_(3)and T_(5)in the two groups all significantly increased(P<0.05),with the HR and MAP at T_(1),T_(2),T_(3)and T_(4)in the observation group being significantly lower than those in the control group at the same time points(P<0.05).The serum levels of NE and COR in the two groups at T_(3)were significantly higher than those at T_(0)(P<0.05),while the levels at T_(5)were lower than those at T_(3)(P<0.05),and the levels of NE and COR at T_(3)and T_(5)in the observation group were significantly lower than those at the same time points in the control group(P<0.05).The VAS scores at 1,6,12 and 24 h after surgery in the two groups displayed a downward trend,and the VAS scores in the observation group at various time points after surgery were significantly lower than those in the control group(P<0.05).The consumption rates of tramadol and pethidine after surgery in the observation group were respectively 32.50%and 5.00%,which were lower than 55.00%and 22.50%in the control group(P<0.05).Conclusion Nalbuphine pretreatment before anesthesia induction of the patients with ACC undergoing LC is beneficial for lowering propofol and sufentanil consumption,decreasing hemodynamic fluctuation and stress response,and consequently alleviating postoperative pain and reducing consumption rate of analgesics.
作者 韩庆 Han Qing(Department of Anesthesiology,Navy Anqing Hospital,Anqing 246000,China)
出处 《海军医学杂志》 2023年第2期173-177,共5页 Journal of Navy Medicine
关键词 急性结石性胆囊炎 腹腔镜胆囊切除术 纳布啡 血流动力学 应激反应 Acute calculous cholecystitis Laparoscopic cholecystectomy Nalbuphine Hemodynamics Stress response
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