不同配伍剂量的纳布啡联合氢吗啡酮对胸腔镜肺癌根治术后患者自控静脉镇痛的临床疗效

Clinical efficacy of different doses of nalbuphine combined with hydromorphone for patient-controlled intravenous analgesia after thoracoscopic radical resection of lung cancer

目的探讨不同配伍剂量的纳布啡联合氢吗啡酮在胸腔镜肺癌根治术后患者自控静脉镇痛中的临床疗效。方法选取浙江省龙游县人民医院2022年1月至2023月12月收治的择期行胸腔镜肺癌根治术120例为研究对象,随机数字表法分入3组,A组(40例)经静脉自控镇痛(PCIA)药物配置为纳布啡0.75 mg/ml+氢吗啡酮25μg/ml,B组(40例)为纳布啡0.5 mg/ml+氢吗啡酮50μg/ml,C组(40例)为纳布啡0.25 mg/ml+氢吗啡酮75μg/ml。观察并记录患者术后48 h内不同时间点的静息状态及活动状态下的疼痛数字等级评定量表(NRS)评分、PCIA总按压次数和有效按压次数、补救镇痛次数以及不良反应发生情况,并使用疼痛控制满意度调查表(PTSS)评估患者对于术后疼痛控制的满意度。结果重复测量方法分析结果显示,不同时间测量的静息状态及活动状态下的NRS评分差异具有统计学意义(P<0.05);测量时间和组别间不存在交互作用(P>0.05);组别间方差分析结果差异具有统计学意义(P<0.05),且A组术后8 h、12 h、24 h、48 h时的静息以及活动状态下的NRS评分及PCIA按压次数高于其他组。C组的恶心、呕吐的不良反应发生率高于A组、B组(P<0.05)。3组患者补救镇痛例数差异具有统计学意义,且A组补救镇痛例数最多(P<0.05)。3组患者PTSS评分差异具有统计学意义,且B组评分高于A组、C组(P<0.05)。结论胸腔镜肺癌根治术后患者应用纳布啡0.5 mg/ml+氢吗啡酮50μg/ml的PCIA配置方案可获得良好的镇痛效果,不良反应发生率低,具有临床推广使用价值。

Objective To investigate the clinical efficacy of different doses of nalbuphine combined with hydromorphone for patient-controlled intravenous analgesia(PCIA)after radical resection of lung cancer under thoracoscope.Methods A total of 120 patients undergoing thoracoscopic radical resection of lung cancer in Longyou County People′s Hospital of Zhejiang Province from January 2022 to December 2023 were vided into three groups by random number table method.Group A(n=40)received PCIA with nalbuphine 0.75 mg/ml+hy-dromorphone 25μg/ml,group B(n=40)received nalbuphine 0.5 mg/ml+hydromorphone 50μg/ml,and group C(n=40)received nalbuphine 0.25 mg/ml+hydromorphone 75μg/ml.The numerical rating scale(NRS)scores in the resting and active states were observed and recorded at 4 h,8 h,12 h,24 and 48 h after surgery.The numerical rating scale(NRS)scores in resting state and active state,the total number of PCIA compressions,the number of effective compressions,the number of rescue analgesia,and the occurrence of adverse reactions were observed and recorded at different time points within 48 hours after operation.The patients′satisfaction with postoperative pain control was evaluated using the pain control satisfaction questionnaire(PTSS).Results Repeated measures analy-sis showed that NRS scores in resting state and active state measured at different time points were statistically dif-ferent(P<0.05).There was no interaction between measurement time and group(P>0.05).The results of variance analysis between the groups were statistically significant(P<0.05),and the NRS scores in the resting and active states and the number of PCIA presses in group A were significantly higher than those in other groups at 8 h,12 h,24 h and 48 h after operation.The incidence of nausea and vomiting in group C was higher than that in group A and group B(P<0.05).The difference in the number of rescue analgesia among the three groups was statistically significant,and the number of rescue analgesia in group A was the highest(P<0.05).There were statistically sig-nificant differences in PTSS scores among the three groups,and the score of group B was higher than that of group A and group C(P<0.05).Conclusion The PCIA regimen of nalbuphine 0.5 mg/ml+hydromorphone 50μg/ml can achieve good analgesic effect and low incidence of adverse reactions in patients after radical resection of lung cancer under thoracoscope,which is worthy of clinical application.