不同剂量纳布啡联合七氟醚对小儿麻醉术后镇痛及血流动力学的影响

Effects of Different Doses of Nalbuphine Combined with Sevoflurane on Analgesia and Hemodynamics after Anes⁃thesia in Children

目的:观察不同剂量纳布啡联合七氟醚对小儿麻醉术后的镇痛效果及对术后血流动力学的影响。方法:选取2022年5—10月安顺市妇幼保健院收治的行腹腔镜疝气修补术患儿100例作为研究对象,所有患儿于手术切皮前5 min给予纳布啡,根据纳布啡剂量分为低剂量组(n=34,0.15 mg/kg)、中剂量组(n=33,0.2 mg/kg)、高剂量组(n=33,0.25 mg/kg)。比较三组患儿不同时间点血流动力学指标、镇痛效果及恢复情况。结果:三组患儿苏醒后6 h(T_(2))时的收缩压(SBP)、舒张压(DBP)、心率(HR)高于苏醒即刻(T_(1)),且高剂量组、中剂量组低于低剂量组;三组苏醒后12 h(T_(3))、苏醒后24 h(T_(4))时的SBP、DBP、HR低于T_(2)时,且高剂量组低于中剂量组低于低剂量组,差异均有统计学意义(P<0.05)。三组T_(2)时的术后疼痛评分(CHEOPS评分)高于T_(1)时,Ramsay镇静评分低于T_(1)时,且高剂量组、中剂量组均优于低剂量组;三组T_(3)、T_(4)时的CHEOPS评分低于T_(2)时,且高剂量组、中剂量组低于低剂量组;三组T_(3)时的Ramsay镇静评分低于T_(2)时,T_(4)时的Ramsay镇静评分高于T_(2)、T_(3)时,且高剂量组、中剂量组高于低剂量组,差异均有统计学意义(P<0.05)。低剂量组、中剂量组术后排气下床活动时间短于高剂量组,差异有统计学意义(P<0.05)。结论:不同剂量纳布啡联合七氟醚对小儿麻醉术后镇痛效果较好,且对血流动力学影响较小,但0.2 mg/kg纳布啡联合七氟醚对患儿镇痛效果更好,可维持血流动力学稳定,促进术后恢复。

Objective:To observe the analgesic effectofdifferentdoses ofnalbuphine combined with sevoflurane on postoperative he⁃modynamics in children after anesthesia.Methods:A total of 100 children who underwent laparoscopic hernia repair from May to Oc⁃tober 2022 in Anshun Maternal and Child Health Hospital were selected as the study subjects.All children were given nalbuphine 5 minutes before surgical dermectomy.According to the dose,nalbuphine was divided into low dose group(n=34,0.15 mg/kg),medium dose group(n=33,0.2 mg/kg)and high dose group(n=33,0.25 mg/kg).The hemodynamic indexes,analgesic effect and recovery of the three groups were compared at different time points.Results:The systolic blood pressure(SBP),diastolic blood pressure(DBP)and heart rate(HR)of the three groups at 6 h(T_(2))after awakening were higher than those immediately after awakening(T_(1)),and the highdose and medium-dose groups were lower than those of low-dose groups.SBP,DBP and HR of the three groups at 12 h(T_(3))and 24 h(T_(4))after awakening were lower than T_(2),and the high-dose group was lower than the medium-dose group than the low-dose group,with statistical significance(P<0.05).The postoperative pain score(CHEOPS score)of the three groups at T_(2)was higher than T_(1),and the Ramsay sedation score was lower than T_(1),and the high-dose and medium-dose groups were better than the low-dose group.The CHEOPS scores in T_(3)and T_(4)were lower than those in T_(2),and the high-dose and medium-dose groups were lower than those in lowdose groups.The Ramsay sedation score at T_(3)was lower than that at T_(2),the Ramsay sedation score at T_(4)was higher than that at T_(2)and T_(3),and the high-dose and medium-dose groups were higher than the low-dose groups,with statistical significance(P<0.05).The ac⁃tivity time of postoperative exhaust in low dose group and medium dose group was shorter than that in high dose group,the difference was statistically significant(P<0.05).Conclusion:Different doses of nalbuphine combined with sevoflurane have better analgesic ef⁃fect on children after anesthesia,and have little effect on hemodynamics,but 0.2 mg/kg of nalbuphine combined with sevoflurane has better analgesic effect on children,which can maintain stable hemodynamics and promote postoperative recovery.