右美托咪啶联合纳布啡镇痛方案对腹腔镜胆囊切除术患者的影响

The Impact of Dexmedetomidine Combined with Nalbuphine Analgesic Regimen on Patients Undergoing Laparoscopic Cholecystectomy

目的探究右美托咪啶联合纳布啡镇痛方案在腹腔镜胆囊切除术患者中应用效果。方法选择2021年1月至2023年1月在获嘉县人民医院进行腹腔镜手术的94例患者,应用随机数表法将其分为对照组(麻醉诱导+维持麻醉+右美托咪啶镇痛)及观察组(右美托咪啶镇痛联合纳布啡镇痛方案)各47例,对比两组临床指标、血流动力学、凝血功能、疼痛评分[视觉模拟量表(VAS)]、Ramsay镇静评分、简易精神状态量表(MMSE量表)、应激反应、并发症发生率。结果观察组拔管时间、睁眼时间、定向力恢复时间短于对照组,差异有统计学意义(P<0.05)。术后24 h观察组心率(HR)、收缩压(SBP)、舒张压(DBP)低于对照组,差异有统计学意义(P<0.05)。对照组术后7天D-二聚体(DD)、纤维蛋白原(FIB)低于观察组,差异有统计学意义(P<0.05);两组活化部分凝血活酶时间(APTT)、凝血酶原时间(PT)对比差异无统计学意义(P>0.05)。观察组VAS、Ramsay、MMSE评分优于对照组,差异有统计学意义(P<0.05)。观察组拔管后超氧化物歧化酶(SOD)、丙二醛(MDA)低于对照组,差异有统计学意义(P<0.05);对照组总抗氧化能力(T-AOC)低于观察组,差异有统计学意义(P<0.05)。观察组并发症发生率低于对照组,差异有统计学意义(P<0.05)。结论腹腔镜胆囊切除术中采用右美托咪啶联合纳布啡镇痛方案,麻醉效果显著,可稳定血流动力学,降低疼痛程度及并发症发生率,对凝血功能影响较少,减轻应激反应,保护患者认知功能。

Objective To explore the application effect of dexmedetomidine combined with nalbuphine analgesic regimen in patients undergoing laparoscopic cholecystectomy.Methods From January 2021 to January 2023,94 patients who underwent laparoscopic surgery in the People’s Hospital of Huojia County were selected.They were divided into a control group(anesthesia induction+maintenance anesthesia+dexmedetomidine analgesia)and an observation group(dexmedetomidine analgesia combined with nalbuphine analgesic regimen)with 47 cases each using a random number table method.The clinical indicators,hemodynamics,coagulation function,pain score[Visual Analogue Scale(VAS)],Ramsay sedation score,Mini-Mental State Examination(MMSE),stress response,and complication incidence rate of the two groups were compared.Results The extubation time,eye-opening time,and orientation recovery time of the observation group were shorter than those of the control group,and the difference was statistically significant(P<0.05).After 24 hours of surgery,the heart rate(HR),systolic blood pressure(SBP),and diastolic blood pressure(DBP)of the observation group were lower than those of the control group,and the difference was statistically significant(P<0.05).The D-dimer(DD)and fibrinogen(FIB)of the control group were lower than those of the observation group 7 days after surgery,and the difference was statistically significant(P<0.05);there was no statistical significance in the comparison of activated partial thromboplastin time(APTT)and prothrombin time(PT)between the two groups(P>0.05).The VAS,Ramsay,and MMSE scores of the observation group were better than those of the control group,and the difference was statistically significant(P<0.05).The superoxide dismutase(SOD)and malondialdehyde(MDA)of the observation group were lower than those of the control group after extubation,and the difference was statistically significant(P<0.05);the total antioxidant capacity(T-AOC)of the control group was lower than that of the observation group,and the difference was statistically significant(P<0.05).The incidence rate of complications in the observation group was lower than that in the control group,and the difference was statistically significant(P<0.05).Conclusion The use of dexmedetomidine combined with nalbuphine analgesic regimen in laparoscopic cholecystectomy has a significant anesthetic effect,can stabilize hemodynamics,reduce pain and the incidence of complications,has less impact on coagulation function,reduces stress response,and protects patients’cognitive function.