纳布啡作为佐剂行腹横肌平面阻滞对腹腔镜结直肠癌手术患者术后疼痛及恢复质量的影响

Effect of transversus abdominis plane block with Nalbuphine as an adjuvant on pain and recovery quality in patients with laparoscopic colorectal cancer surgery

目的探讨腹腔镜结直肠癌患者采用纳布啡作为佐剂行腹横肌平面阻滞(TAPB)对其术后疼痛及恢复质量的影响。方法选取2022年1月至10月九江市第一人民医院收治的60例行腹腔镜结直肠癌根治术的患者作为研究对象,采用随机数字表法将其分为R组(n=30)与RN组(n=30),R组采用罗哌卡因进行TAPB,RN组采用纳布啡+罗哌卡因混合液进行TAPB。比较两组术后疼痛、恢复质量、镇痛泵按压次数以及不良反应。结果静息时,两组患者的视觉模拟评分法(VAS)评分时间、组间、交互效应比较,差异无统计学意义(P>0.05);咳嗽时,两组患者的VAS评分时间、组间比较,差异有统计学意义(P<0.05),两组交互效应比较,差异无统计学意义(P>0.05);组内比较:R组术后6、12、24、48 h时VAS评分高于术后3 h,术后24、48 h时的VAS评分高于6 h,术后48 h时的VAS评分高于术后12 h,差异有统计学意义(P<0.05);RN组术后3、6、12、24 h的VAS评分两两比较,差异均无统计学意义(P>0.05);组间比较:RN组患者术后6、12、24 h的VAS评分低于R组,两组患者术后3、48 h的VAS评分比较,差异无统计学意义(P>0.05)。术后3 d,RN组的40项恢复质量评分量表(QoR-40)评分均高于R组,差异有统计学意义(P<0.05)。RN组术后24 h内镇痛泵按压次数少于R组,差异有统计学意义(P<0.05)。RN组患者的不良反应总发生率(13.32%)低于R组(36.66%),差异有统计学意义(P<0.05)。结论纳布啡作为佐剂行TAPB可缓解结直肠癌根治术患者术后疼痛、提升恢复质量、减少术后镇痛泵按压次数并降低不良反应发生率,具有良好的临床应用价值。

Objective To investigate the effect of transversus abdominis plane block(TAPB)with Nalbuphine as an adjuvant on pain and recovery quality in patients after laparoscopic radical resection of colorectal cancer.Methods Sixty patients undergoing laparoscopic radical resection of colorectal cancer treated in Jiujiang First People's Hospital from January to October 2022 were selected as the study objects.Random number table method was used to divide them into R group(n=30)and RN group(n=30).Ropivacaine was used for TAPB in R group.The RN group received TAPB with Nalbuphine+Ropivacaine mixture.Postoperative pain,recovery quality,number of analgesic pump compressions and adverse reactions were compared between the two groups.Results At rest,there was no significant difference in VAS score time,inter-group and interaction effect between the two groups(P>0.05).When coughing,there were statistically significant differences in VAS score time and inter-group comparison between the two groups(P<0.05),but no statistically significant differences in interaction effects between the two groups(P>0.05).Intra-group comparison:the VAS score at 6,12,24 and 48 h after operation was higher than that at 3 h after operation,the VAS score at 24 and 48 h after operation was higher than that at 6 h after operation,and the VAS score at 48 h after operation was higher than that at 12 h after operation,with statistical significances(P<0.05).There was no significant difference in VAS scores of the RN group at 3,6,12,24 h after surgery(P>0.05).Comparison between groups:The VAS scores of RN group at 6,12 and 24 h after surgery were lower than those of R group,and there was no statistical significance in VAS scores of 3 and 48 h after surgery between the two groups(P>0.05).At 3 days after surgery,the 40-item recovery quality score scale(QoR-40)score of RN group was higher than that of R group,and the difference was statistically significant(P<0.05).The number of analgesic pump compressions in RN group was less than that in R group within 24 h after surgery,and the difference was statistically significant(P<0.05).The total incidence of adverse reactions in RN group(13.32%)was lower than that in R group(36.66%),and the difference was statistically significant(P<0.05).Conclusion TAPB with nalbuphine as an adjuvant can relieve pain,improve recovery quality,and reduce analgesia pump pressing times and the incidence of adverse reactions in patients after laparoscopic radical resection of colorectal cancer.