纳布啡复合氢吗啡酮对腹腔镜全子宫切除术后镇痛及应激状态的影响

Effects of nalbuphine combined with hydroxymorphone used in laparoscopic total hysterectomy of patients on their postoperative analgesia and stress status

目的:观察纳布啡复合氢吗啡酮对腹腔镜全子宫切除术后镇痛及应激状态的影响。方法:选取2021年12月-2023年3月本院行腹腔镜全子宫切除术患者160例,按照随机数字表法分为纳布啡复合氢吗啡酮组(复合吗啡酮组)、纳布啡复合舒芬太尼组(复合舒芬太尼组)各80例。两组均行气管插管静脉全麻,术后48 h内患者自控静脉镇痛(PCIA),药物配伍分别为N+H组给予纳布啡0.8 mg/kg+氢吗啡酮0.1 mg/kg,N+S组给予纳布啡0.8 mg/kg+舒芬太尼2.0μg/kg,均加生理盐水配置为100 ml混合液。记录两组术后48 h内静息时、活动时视觉模拟量表(VAS)评分、镇痛泵总按压次数、有效按压次数、补救镇痛比例、托烷司琼用量、不良反应及术后恢复情况;观察术前、术后6 h、24 h应激指标[皮质醇(Cor)、血管紧张素Ⅱ(Ang-Ⅱ)]水平。结果:复合吗啡酮组组术后6 h、12 h、24 h静息时、活动时VAS评分均低于复合舒芬太尼组,且术后48 h活动时VAS评分也低于复合舒芬太尼组;术后48 h内镇痛泵总按压(5.7±2.0次)、有效按压(3.9±1.3次)、补救镇痛比例(6.3%)、托烷司琼用量(0.2±0.1mg)及恶心(10.0%)、头晕(6.3%)发生率均低于复合舒芬太尼组(10.9±3.0次、6.7±2.2次、17.5%、0.5±0.1 mg、22.5%、20.0%);术后6 h、24 h两组血清Cor、Ang-Ⅱ水平均高于术前,但复合吗啡酮组(389.28±26.51 nmol/L、389.28±26.51 nmol/L,207.42±15.38 nmol/L、168.85±12.64 nmol/L)均低于复合舒芬太尼组(457.43±31.39 nmol/L、384.58±21.40 nmol/L,236.37±18.50 nmol/L、180.49±14.15 nmol/L);复合吗啡酮组术后首次下床活动时间(14.57±2.06h)短于复合舒芬太尼组(16.24±2.37h)(均P<0.05 nmol/L)。结论:纳布啡复合氢吗啡酮可提高腹腔镜全子宫切除术后镇痛效果,减轻术后应激水平,促进术后恢复,且安全性较好高。

Objective:To observe the effects of nalbuphine combined with hydroxymorphone used in laparoscopic total hysterectomy of patients on their postoperative analgesia and stress status.Methods:A total of 160 patients who wanted laparoscopic total hysterectomy were selected and randomly divided into two groups(80 cases in each group) between December 2021 and March 2023.The patients in both groups were given endotracheal intubation and intravenous general anesthesia and the patient-controlled intravenous analgesia(PCIA) within 48 hours after operation.The patients in group A were given nalbuphine 0.8 mg/kg combined with hydroxymorphone 0.1 mg/kg mixed with saline to a total volume of 100 ml for PCIA,and the patients in group B were given nalbuphine 0.8 mg/kg combined with sufentanil 2.0 μg/kg mixed with saline to a total volume of 100 ml for PCIA.The visual analog scale(VAS) score of the patients within postoperative 48h at rest and at activity,the total number of analgesic pump presses,the effective press count,the proportion of remedial analgesia,the dosage of tropisetron used,the adverse reactions rate,and the postoperative recovery situation of the patients in the two groups were recorded.The levels of stress indicators,such as cortisol(Cor)and angiotensin Ⅱ(Ang-Ⅱ),of the patients before surgery and in postoperative 6hand 24hwere observed.Results:The VAS scores of the patients in group A at 6h,12h,and 24hafter operation at rest and at activity were significantly lower than those of the patients in group B,and the VAS score of the patients in group A at 48hafter operation at activity was also significantly lower than that of the patients in group B.The number of total analgesic pump compressions(5.7±2.0times),the number of effective analgesic pump compressions(3.9±1.3times),the proportion of analgesia relieved(6.3%),the dosage of troanistron used(0.2±0.1mg),and the rates of nausea(10.0%)and dizziness(6.3%)of the patients in group A were significantly lower than those(10.9±3.0times,6.7±2.2times,17.5%,0.5±0.1mg,22.5%,and 20.0%)of the patients in group B.The levels of serum Cor and Ang-Ⅱ of the patients in both groups at 6hand 24hafter operation were significantly higher than those before operation,but which(389.28±26.51nmol/L,389.28±26.51nmol/L,207.42±15.38nmol/L,and 168.85±12.64nmol/L,respectively)of the patients in group A were significantly lower than those(457.43±31.39nmol/L,384.58±21.40nmol/L,236.37±18.50nmol/L,and 180.49±14.15nmol/L,respectively)of the patients in group B.The first time of getting out of bed(14.57±2.06h)of the patients in group A was significantly shorter than that(16.24±2.37h)of the patients in group B(all P<0.05).Conclusion:Nalbuphine combined with hydroxymorphone used in PCIA of the patients after laparoscopic total hysterectomy can improve their postoperative analgesic effect,alleviate their postoperative stress level,promote their postoperative recovery,and with higher safety.