纳布啡复合依托咪酯对腹腔镜胆囊切除术患者的作用效果

Effects of Nalbuphine Combined with Etomidate in Patients Undergoing Laparoscopic Cholecystectomy

目的探讨纳布啡复合依托咪酯在腹腔镜胆囊切除术(LC)中的应用价值。方法采用配对病例对照研究法,回顾性选取2020年9月至2023年9月在医院接受LC治疗的90例患者,按麻醉方案分为对照组、研究组,各45例。两组均接受全身麻醉,其中接受依托咪酯麻醉的设为对照组,接受纳布啡复合依托咪酯麻醉的设为研究组。以麻醉前(T_(0))、诱导后10 min(T_(1))、建立气腹时(T_(2))、术毕后20 min(T_(3))为时间节点,比较两组血流动力学指标[心率(HR)、平均动脉压(MAP)]、脑氧代谢指标[脑氧摄取率(CEO_(2))、颈内静脉球血氧饱和度(SjvO_(2))]水平。比较两组术前及术后3、6、12、24 h的视觉模拟评分法(VAS)评分。比较两组术前、术后1 d的应激反应指标[血清皮质醇(Cor)、促肾上腺皮质激素(ACTH)]水平。比较两组麻醉苏醒期躁动发生情况及不良反应。结果两组HR、MAP组间、时间、交互效应有统计学意义(P<0.05);研究组T_(1)、T_(2)、T_(3)时SjvO_(2)水平高于对照组,CEO_(2)水平低于对照组(P<0.05);研究组3、6、12、24 h VAS评分低于对照组(P<0.05);研究组术后1 d Cor、ACTH水平低于对照组(P<0.05);研究组术后苏醒期SAS评分低于对照组(P<0.05);研究组麻醉苏醒期躁动率(13.33%)低于对照组(33.33%)(P<0.05);研究组不良反应总发生率(13.33%)与对照组(4.44%)相比,差异无统计学意义(P>0.05)。结论纳布啡复合依托咪酯可有效稳定LC患者术中血流动力学水平,改善脑代谢,缓解术后疼痛,减轻应激反应、躁动反应,且安全性可靠。

Objective To investigate the application value of nalbuphine combined with etomidate in laparoscopic cholecystectomy(LC).Methods A paired case-control study was used to retrospectively select 90 patients who underwent LC treatment in the hospital from September 2020 to September 2023,and were divided into control group and study group according to anesthesia protocols,with 45 cases in each group.The two groups were given general anesthesia,the control group was given etomidate anesthesia,and the study group was given nalbuphine combined with etomidate anesthesia.The time nodes were before anesthesia(T_(0)),10 minutes after induction(T_(1)),when pneumoperitoneum was established(T_(2)),and 20 minutes after surgery(T_(3)).The hemodynamic indexes[heart rate(HR),mean arterial pressure(MAP)],cerebral oxygen metabolism indexes[cerebral oxygen uptake rate(CEO_(2)),internal jugular bulbar blood oxygen saturation(SjvO_(2))]of the two groups were compared.The visual analogue scale(VAS)scores of the two groups were compared before surgery,3,6,12 and 24 hours after surgery.The stress response indexes[serum cortisol(Cor)and adreno-cortico-tropic-hormone(ACTH)]of the two groups were compared before and 1 day after surgery.The occurrence of agitation and adverse reactions during anesthesia recovery were compared between the two groups.Results There was a statistical difference in the group,time and interaction effects of HR and MAP of the two groups(P<0.05).SjvO_(2)level in study group was higher than that in control group at T_(1),T_(2)and T_(3),and CEO_(2)level was lower than that in control group(P<0.05).The VAS scores at 3,6,12 and 24 hours in study group were lower than those in control group(P<0.05).The levels of Cor and ACTH in study group were lower than those in control group 1 day after operation(P<0.05).The SAS score of study group was lower than that of control group(P<0.05).The agitation rate in study group(13.33%)was lower than that in control group(33.33%)(P<0.05).There was no statistical difference in the total incidence of adverse reactions between study group(13.33%)and control group(4.44%)(P>0.05).Conclusion Nalbuphine combined with etomidate can effectively stabilize the hemodynamic level of LC patients during operation,improve brain metabolism,relieve postoperative pain,relieve stress reaction and agitation reaction,and is safe and reliable.