右美托咪定联合纳布啡术后PCIA在TURP患者术后镇痛中的应用效果

Effect of PCIA after dexmedetomidine combined with nalbuphine in postoperative analgesia in patients with TURP

目的探讨右美托咪定联合纳布啡术后自控静脉镇痛(PCIA)对经尿道前列腺电切术(TURP)患者术后镇痛镇静及炎症指标的影响。方法选取2021年1月至2022年8月该院收治的80例TURP患者作为研究对象,按随机数字表法将其分为对照组和观察组,每组40例。对照组采用纳布啡联合托烷司琼术后PCIA,观察组在对照组基础上加用右美托咪定术后PCIA。比较两组的疼痛程度[视觉模拟评分法(VAS)]及镇静程度[Ramsay镇静评分(RSS)]、炎症指标[白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)]水平、PCIA泵总按压次数。结果VAS评分与RSS评分均存在组间效应、时间效应和交互效应(P<0.001),且观察组术后12、24、48 h的VAS评分低于对照组(F=60.560,P<0.001;F=19.909,P<0.001;F=176.704,P<0.001),而术后12、24、48 h的RSS评高于对照组(F=26.030,P<0.001;F=48.944,P<0.001;F=66.341,P<0.001)。IL-6、TNF-α水平存在时间效应、组间效应和交互效应(P<0.001),且且观察组术后24、48 h的IL-6水平低于对照组(F=5.108,P=0.027;F=36.192,P<0.001),术后24、48 h的TNF-α水平低于对照组(F=32.844,P<0.001;F=18.879,P<0.001)。观察组术后48 h内PCIA泵总按压次数[(9.12±0.91)次]低于对照组[(13.21±1.32)次],差异有统计学意义(t=16.134,P<0.001)。结论右美托咪定联合纳布啡术后PCIA可减少TURP患者术后镇痛泵按压次数,提高镇痛镇静效果,减轻炎症反应。

Objective To investigate the effects of dexmedetomidine combined with nalbuphine postoperative controlled intravenous analgesia(PCIA)on postoperative analgesia,sedation and inflammation indexes in patients undergoing transurethral resection of prostate(TURP).Methods A total of 80 patients with TURP admitted to the hospital from January 2021 to August 2022 were selected and divided into control group and observation group according to random number table method,40 cases in each group.The control group received nbuphine combined with tropisetron for postoperative controlled intravenous analgesia(PCIA),and the observation group received dexmedetomidine for postoperative PCIA on the basis of the control group.The pain degree[visual analogue scale(VAS)]and sedation degree[Ramsay sedation score(RSS)],inflammatory indicators[interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)]levels and total PCIA pump compressions were compared between the two groups.Results There were between-group effects,time effects and interaction effects for VAS score and RSS score(P<0.001),and the VAS scores of the observation group at 12,24,48 h after surgery were lower than those of the control group(F=60.560,P<0.001;F=19.909,P<0.001;F=176.704,P<0.001),while the RSS score 12,24,48 h after surgery were higher than those of the control group(F=26.030,P<0.001;F=48.944,P<0.001;F=66.341,P<0.001).There were time effects,between-group effects and interaction effects for the levels of IL-6 and TNF-α(P<0.001),and and the IL-6 levels in the observation group at 24 and 48 h postoperatively were lower than those in the control group(F=5.108,P=0.027;F=36.192,P<0.001),the TNF-αlevels at 24 and 48 h postoperatively were lower than those in the control group(F=32.844,P<0.001;F=18.879,P<0.001).The total number of PCIA pump compressions[(9.12±0.91)times]in the observation group was lower than that in the control group[(13.21±1.32)times]in 48 h postoperatively,and the difference was statistically significant(t=16.134,P<0.001).Conclusion Postoperative PCIA with dexmedetomidine combined with nalbuphine can reduce the number of postoperative analgesic pump compressions in patients with TURP,improve the analgesic and sedative effect,and reduce inflammation.